1. Recipient ID.
2. Social Security Number and Date of Birth.
3. Last Name, First Name, Middle Name, and Social Security Number.
4. Last Name, First Name, Middle Name, and Date of Birth.
Dates
Response Data
Benefits
The following information is based on a generic “Health Benefit Plan Coverage - 30” inquiry.
The 5010 response now returns a Group or Policy Number (REF01=IL) in the 2100C loop.
The name of the County is no longer returned in the response.
The response no longer returns a message segment with the base type information.
Previously, base type messages were returned.
For example, “Base Type 13 = Individual Outside Title XIX Facility” is no longer indicated.
This payer only supports a general benefits inquiry. If a Service Type Code other than
those supported by the payer is received, the transaction is processed as if a Service Type Code 30
(General Benefits Inquiry) is received.
Disclaimer
This document is not intended to identify every scenario that may be
presented in the payer response.