Santa Clara Valley Health Plan (Commercial) - Quick Reference, What You Need to Know...
Search Options
- This
payer supports five search options as listed below.
1. Subscriber ID, Last Name,
First Name, and Date of Birth.
2. Subscriber ID, and Date of Birth.
3. Social Security Number, and Last Name.
4. Last Name, First Name, and Date of Birth.
5. Social Security Number, and Date of Birth.
-
For successful transaction processing, dependent data may be promoted to
the subscriber loop.
Dates
-
No changes in date rules. However, inquiry dates
now reference a Plan Date - 291 (DTP01).
-
The response may return a Plan Date - 291
(DTP01) or a Plan Begin Date – 346 (DTP01) in the
2100C Loop. Previously, this information was returned in the 2110C Loop
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.