Molina (All States) - 5010 Quick Reference, What You Need to Know...
Search Options
-
No changes in search options or search criteria. The Group Number is
optional,
but if used may also improve the results.
1. Subscriber ID and Group
Number.
2. Recipient Last Name, Recipient First Name, Recipient Date of Birth,
and Group Number.
3. Recipient ID, Recipient Last Name, Recipient First Name, Recipient
Date of Birth, and Group Number.
- For
successful transaction processing, dependent data may be promoted to the
subscriber loop.
Dates
-
No changes in date rules. This payer
requires only the begin date for an inquiry.
-
This payer supports, up to two years in
the past.
-
No future dates or date spans are 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.
-
The
5010 response now returns multiple service type codes in the
eligibility benefit loop (EB03).
Examples located only during a Not Covered response. (EB01=I)
-
The
5010 response now uses service type codes for Physician Office Visit
Sick – BY,
Physician Office Visit Well – BZ, Mental Health – MH, and Urgent
Care – UC.
-
The
primary difference between the 4010 and 5010 responses is that the
4010 response contained
Message Segments (MSG) what is now codified in the 5010 response.
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.