Missouri (Medicaid) - Quick Reference, What You Need to Know...
Search Options
-
Basically, there are no changes in search options. This payer still
supports the following search options.
The optional Middle Name field was removed.
1. Recipient ID.
2. Social Security Number, and Date of Birth.
3. Last Name, First Name, and Social Security Number.
4. Casehead Medicaid ID, and Dependent Date of Birth.
- For
successful transaction processing, dependent data may be promoted to the
subscriber loop.
- This
payer expects a Taxonomy Code included with the Provider’s NPI. This
payer also allows the
Taxonomy Code to be included and passed in the EDI transaction.
- This
payer requires special header information which is added prior to
processing by the payer.
- This
payer does not accept the carat “^” character in the ISA11 segment.
Dates
-
Basically, there are no changes to the
date rules. Both begin and end dates are used for an inquiry.
-
This payer supports up to one year in the
past. Future dates up to the end of the current month are supported.
Date spans up to a 31-day range are also supported.
-
Dates now reference a Plan Date – 291
(DTP01). Previously, date references for Eligibility – 307 were used.
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 returns service type codes for Emergency Services
– 86,
Pharmacy – 88, and Office Visits – 98, where applicable.
Previously, the service type code for General Benefits – 60 was
used.
-
Both
the County and County Code are not returned.
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.