1. Subscriber ID, Patient Last Name, Patient First Name, Patient Date of Birth, and Relationship to Subscriber.
2. Subscriber ID, Patient Last Name, Patient First Name, and Relationship to Subscriber.
3. Subscriber ID, Patient Date of Birth, and Relationship to Subscriber.
Response Data
Benefits
The following information is based on a generic Health Benefit Plan Coverage - 30 inquiry.
The handicap indicator (INS10) is no longer supported in the 5010 response.
The 5010 response now uses service type codes for Physician Office Visit Sick BY,
Physician Office Visit Well BZ, Urgent Care UC, and Mental Health MH.
The 5010 response now returns multiple service type codes in the eligibility benefit loop (EB03).
This payer has stopped using the U designation for In Plan and Out of Plan Network (EB12=U).
Now, they extensively use a W for both In Plan and Out of Plan Network (EB12=W).
For Chiropractic 33, the response returns eligibility segments for coverage, co-payment,
co-insurance, and visit limitations when applicable.
For Medicaid Supplement Plans, with active coverage, more detailed service type codes are provided.
For example, the response now provides service type codes for Chiropractic 33, Hospital Inpatient 48,
Hospital Outpatient 50, Hospital Emergency Medical 52, Emergency Services 86, and Professional Physician
Office Visit 98. Previously, only active coverage for Medical Care 1 and Health Benefit Plan Coverage 30
were provided.
The 5010 response now returns eligibility and benefit loops for Other Additional Payer, Hospital Outpatient.
(EB01=R and EB03=50)
Eligibility benefit loops for not covered, major medical are no longer being returned.
(EB01=I and EB03=55)