Ohio (Medicaid) - Quick Reference, What You Need to Know...
Search Options
-
Basically, there are no changes in search options or search criteria.
As in the past, this payer supports the following search options.
1. Recipient ID and Date of
Birth.
2. Recipient ID, Last Name, and First Name.
3. Social Security Number and Date of Birth.
4. Social Security Number, Last Name, and First Name.
5. Last Name, First Name, and Date of Birth.
- For
successful transaction processing, dependent data may be promoted to the
subscriber loop.
Dates
-
Basically, there are no changes in date
rules. This payer supports dates up to two years in the past.
No future dates are allowed. Up to a 31-day date span are also
supported.
-
Inquiry dates now reference a Plan Date –
291 (DTP01), rather than Eligibility Dates - 307.
Response Data
Benefits
The following information is based on a
generic “Health Benefit Plan Coverage - 30” inquiry.
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.