Medi-Cal
(Medicaid) - Quick Reference, What You Need to Know...
Search Options
- As
before, this payer requires an NPI or Legacy Provider ID as well as the
Provider's associated PIN number.
- No
changes in search options or search criteria. As before, this payer supports the
following search option.
The patient's SSN may be used as the Insured ID. The Card Issue
Date is optional.
1. Insured ID, Patient Date
of Birth, and Card Issue Date.
- For
successful transaction processing, dependent data may be promoted to the
subscriber loop.
Dates
-
This payer supports up to one year in the
past and future dates up to the end of the current month.
-
Date spans are not allowed.
-
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.
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.