Todays Options (Medicare) - Quick Reference, What You Need to Know...
Search Options
-
Basically, there are no changes in search criteria. This payer supports
a single search option.
1. Subscriber ID, Last Name,
First Name, and Date of Birth.
- For
successful transaction processing, dependent data may be promoted to the
subscriber loop.
Dates
-
This payer uses both begin and end dates
for an inquiry. Previously, the current date of service was used.
-
This payer supports up to three years in
the past and up to a 90-day date span. No future dates are allowed.
-
Inquiry dates now reference a Plan Date –
291 (DTP01). Plan Dates are also returned on the response.
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).
-
The
5010 response now uses service type codes for Mental Health – MH,
and Urgent Care – UC.
-
It
was observed that both the 4010 and 5010 response returned active
and inactive benefits for
the same service type code for a single date. At the time of this
comparison, the meaning of this
observation is unclear.
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.