Medica (Commercial) - Quick Reference, What You Need to Know...
Search Options
-
Previously, this payer offered six search options. Now, this payer
offers seven
different search options as described below.
1. Subscriber ID, Patient Last Name, Patient First Name, Patient Date of Birth, Group Number,
and Relationship to Subscriber.
2. Subscriber ID, Patient Last Name, Patient First Name, Group Number, and
Relationship to Subscriber.
3. Subscriber ID, Patient Date of Birth, Group Number, and Relationship to Subscriber.
4. Subscriber Social Security Number, Patient Last Name, Patient First Name, Group Number,
and Relationship to Subscriber.
5. Subscriber Social Security Number, Patient Date of Birth, Group Number, and
Relationship to Subscriber.
6. Patient Last Name, Patient First Name, Patient Date of Birth, Group Number, and
Relationship to Subscriber.
7. Minnesota PMI (Person Master Index ID), Patient Last Name, Patient First Name,
Patient Date of Birth, Group Number, and Relationship to Subscriber.
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For best results, the optional Group Number is recommended for inquiries
to identify a specific
member when multiple groups are found.
-
This payer does not promote dependent data. For this reason, it is
necessary for a transaction
to use either a subscriber or dependent loop, depending on the specified value of the relationship code.
Dates
- This payer requires both begin and end dates for an inquiry.
- This payer supports dates up to 18-months in the past. There are no restrictions on date spans.
- Future dates up to the end of the current month are also allowed.
- Inquiry dates now reference a Plan Date - 291 (DTP01) in a range format.
Response Data