Medical Mutual of Ohio (Commercial) - Quick Reference, What You Need to Know...
Revised 12/19/2012
Search Options
-
Previously, this payer provided three search options. Now, this payer
supports two search options as listed below.
1. Subscriber ID, and
Patient Date of Birth.
2. Subscriber ID, Patient Last Name, Patient First Name, and Patient Date of
Birth.
-
This payer does not promote dependent data. For this reason, it is
necessary for an inquiry to use
either a subscriber or dependent loop.
Dates
-
This payer uses the current begin date for an inquiry.
-
Inquiry dates now reference a Plan Date
291 (DTP01).
-
Response dates now reference a Plan Date 291
(DTP01) and Benefit Date - 292 (DTP01).
-
For different plans, the Plan Begin Date
(DTP01=346) may be returned in the 2110C loop of the response.
-
Date references for Eligibility 307, Plan Begin 346, and Service
472, as previously used in 4010
response are not returned.
-
Previously, the 4010 response contained
also multiple occurrences of EB loops and duplicate DTP segments.
Response Data
Benefits
The following information is based on a
generic Health Benefit Plan Coverage - 30 inquiry.
-
The
5010 response does not provide redundant benefit segments in
Subscriber and
Dependent loops. Redundant general benefits
segments (EB*1*30) are
not included in
the 2110C and 2110D loops of the response. In other words, the
4010 response
contained duplicate benefit segments that have been removed in the
5010 response.
-
The 5010 response now uses the new service type code for Urgent Care
UC.
Previously, a message segment (MSG) was used for Urgent Care
benefits.
-
The
5010 response now provides different DTP segment qualifiers for
eligibility benefits. For
example, the EB segments in the 2110C and 2110D loops now reference
a Plan Date - 291 (DTP01)
and a Benefit Date - 292 (DTP01). Previously, the 4010
response provided the same DTP qualifier
for each date segment.
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.