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Kaiser Foundation Health Plan of the Northwest (Commercial, Medicare).
Kaiser Permanente of Georgia (Commercial).
1.
Subscriber ID, Last Name, First Name, and Date of Birth.
2. Social
Security Number, Last Name, First Name, and Date of Birth.
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 Physician Office Visit Sick – BY,
Physician Office Visit Well – BZ, Mental Health – MH, and Urgent Care – UC.
- Kaiser Permanente of Georgia (Commercial) also uses Generic Prescription Drug Formulary – GF
and Generic Prescription Drug Non-Formulary – GN.
- Message text for benefit descriptions is no longer returned. In other words, MSG segments
are not provided in the 2110C loop when EB01=D. Now, benefit information is returned with
the appropriate service type codes. For example, benefit information is now provided in the
2110C loop with their respective EB segment.
- By default, the inquiry uses a generic “Health Benefit Plan Coverage – 30” service type.
Disclaimer
This document is not intended to identify every scenario that may be
presented in the payer response.