Response Data
Benefits
The following information is based on a generic “Health Benefit Plan Coverage - 30” inquiry.
- The list of coverage added now includes the following service types but varies based on an individual’s coverage. However, in several cases, the response provides this list, but not the active coverage for the generic health benefit plan. (For example, EB*1**30)
Medical Care – 1
Chiropractic – 33
Dental Care – 35
Hospice – 45
Hospital – 47
Emergency Services – 86
Pharmacy – 88
Professional Physician Office Visit – 98
Vision (Optometry) – AL
Mental Health – MH
Urgent Care – UC
- The payer name provided in the 2100A now indicates “MOLINA MEDICAD SOLUTIONS.”
Previously, it was indicated as “New Jersey Medicaid.”- The provider identification in the 2100B loop is now qualified as a provider (NM101=1P).
Previously, the provider identification for a hospital was qualified as a facility (NM101=FA).- Some descriptive text has been removed in the response.
For example, we used to get “PRESUMPTIVE ELIGIBILITY LIMITED; PROGRAM 391” but now,
only the text “PROGRAM 391” is provided.- Program names still appear in messages (MSG) but may be attached to the active coverage
for the Health Benefit Plan Coverage – 30, (as they were in the 4010 response) or the messages
may now be attached to specific lists of service types where the Health Benefit Plan Coverage – 30
is not included.- Message text about packages like “A” and “C” and “G” does not exist in the new 5010.
It is believed these are waivers.
- For Pharmacies Only – In some cases, a PRV segment should be used in the 2100B loop.
It may also be required for a pharmacy to supply a taxonomy code in the inquiry.