Significa Benefit Services (TPA) - Quick Reference, What You Need to Know...
Search Options
-
No changes in search options or search criteria. This payer now supports
the following
search option.
1. Subscriber ID, 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.
- This
payer uses a Legacy Provider ID for transaction processing.
Dates
-
Previously, a begin date was optional.
Now, this payer requires a begin date for an
inquiry.
-
This payer supports dates up to two year
in the past. Future dates are not allowed.
-
A date range up to 30-days is allowed.
-
Inquiry dates now reference a Plan Date –
291 (DTP01).
Response Data
Benefits
The following information is based on a
generic “Health Benefit Plan Coverage - 30” inquiry.
-
The
response now returns the name of the payer as SIGNIFICA BENEFIT
SERVICES.
Previously, it was returned as ERIN GROUP ADMINISTRATORS.
-
No
other changes in response information have been reported or
observed.
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.