Iowa (Medicaid) - Quick Reference, What You Need to Know...
Search Options
-
Basically, there are no changes in search options. This payer supports
the following search options.
1. Recipient ID.
2. Social Security Number and Date of Birth.
3. Social Security Number, Last Name, and First Name.
4. Last Name, First Name, and Date of Birth.
- For
successful transaction processing, dependent data may be promoted to the
subscriber loop.
Dates
-
Basically, there are no changes in dates.
This payer uses a single begin date for an inquiry.
-
Inquiry dates now reference a Plan Date –
291 (DTP01).
-
The 5010 response returns a Plan Date -
291 (DTP01).
Previously, the 4010 response returned the Benefit Date - 292 (DTP01).
Response Data
Benefits
The following information is based on a
generic “Health Benefit Plan Coverage - 30” inquiry.
-
The 5010 response now uses service type codes for Substance Abuse -
AI,
Mental Health – MH, and
Urgent
Care – UC.
-
When
EB01 = U the wording for the Service Type Code is returned in Plan
Name
data field, EB05.
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.