Maine (Medicaid) - Quick Reference, What You Need to Know...
Search Options
-
No changes in search options or search criteria. This payer now supports
the following search options.
1. Recipient ID.
2. Social Security Number and Date of Birth.
- For
successful transaction processing, dependent data may be promoted to the
subscriber loop.
Dates
-
This payer requires both begin and end
dates for an inquiry.
-
This payer now supports dates up to two
years in the past and up to a 90-day date span.
-
No future dates are allowed.
-
Previously, the payer allowed dates up to
one year in the past.
-
Inquiry dates now reference a Plan Date
291 (DTP01).
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).
-
Specific service type codes are also returned. Previously, only a
single generic 30 was
returned. (EB03=30)
-
This payer now returns the Plan Begin Date 346 in 2110C loop.
(DTP01)
-
When applicable, the Primary Care Provider (EB01=L) is designated as
MC Medicaid (EB04).
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.