Health Partners of Minnesota

Health Partners of Minnesota - Quick Reference, What You Need to Know...

Search Options

Previously, this payer offered two search options.
Now, this payer supports the following search options.

1. Provider, Begin Date, End Date, Subscriber ID, Last Name, First Name, and Date of Birth.
2. Provider, Begin Date, End Date, Subscriber ID, Last Name, and First Name.
3. Provider, Begin Date, End Date, Last Name, First Name, and Date of Birth.

For successful transaction processing, dependent data may be promoted to the subscriber loop.
This payer includes Commercial, Medicaid, and Medicare.

Dates

The begin date is required and the end date is optional.
Dates now reference a Plan Date – 291 (DTP01).
Previously, both begin and end dates were used on the inquiry.
Date references for Eligibility – 307, may not be returned.
This payer supports dates up to 12 months in the past and 60 days in the future.
Up to a 60-day date span is allowed.

Response Data

Benefits
The following information is based on a generic “Health Benefit Plan Coverage - 30” inquiry.

Essentially, the content in the 5010 response is the same as previously provided in 4010.
New service type codes are included which offer an improved response.
New service types for Dental Accident (37), Durable Medical Equipment (DM),
Mental Health (MH), Physical Therapy (PT), and Urgent Care (UC) have been added.
The service type for Physical Therapy (PT) may replace other benefit codes that were less specific.
The Medicaid Recipient ID number is now provided in a reference segment (REF*NQ).
This is new for the 5010 response.
Some Medicaid responses provide a list of new dental benefits, which indicate they
cannot be processed (EB*V). These benefits are returned with a message segment
that indicates to call for benefits.

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.

Some content is no longer returned in the X12 5010 271 response. In a similar fashion, some content has been

modified and new response information may be returned. Information that appeared consistent between the

4010 and 5010 responses was not presented in this document.