1. Member ID with Suffix.
2. Member ID without Suffix, Last Name, Partial First Name, and Date of Birth
3. Last Name, First Name, Date of Birth, and Sex.
Dates
Response Data
Benefits
The following information is based on a generic “Health Benefit Plan Coverage - 30” inquiry.
The 5010 response now returns multiple service type codes in the eligibility benefit loop (EB03).
The 5010 response now uses service type codes for Mental Health – MH.
The response now returns message segments with benefit information instead of using the EB13 data element.
For example, a message for allergy shots (MSG*Allergy Injection) is now returned.
Disclaimer
This document is not intended to identify every scenario that may be
presented in the payer response.
It should
also be noted, that the payer response may vary depending on the search
criteria used in the initial inquiry.