Nippon Life Insurance Company (Commercial) - 5010 Quick Reference, What You Need to Know...
Search Options
-
This payer supports a single search option. Previously, the Last
Name and First Name were optional.
Now, both Last Name and First Name are required.
1. Subscriber ID, Patient
Last Name, Patient First Name, Patient Date of Birth, and Relationship
to Subscriber.
- This
payer
does not promote dependent data. For this reason, it is
necessary for a transaction to use
either a subscriber or dependent
loop, depending on the specified value of the relationship code.
Dates
-
No changes in date rules. This payer
requires uses the current date for an inquiry.
-
Inquiry dates now reference a Plan Date -
291 (DTP01).
-
The response now returns the Plan Begin
Date - 346 (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 Urgent
Care – UC.
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.