United Healthcare - UHC - 5010 Service Types

United Healthcare - UHC (Commercial) - 5010 Service Type Notice

As a part of the mandated 5010 conversion, UHC has made several changes to their eligibility transaction.
They now allow providers to request benefits for specific service types when making an eligibility inquiry.
This allows you to request only the benefits that meet your particular business needs. Because you can
now request specific benefits, UHC has significantly reduced the amount of benefits returned when making
a nonspecific generic request.

Web-Based Clients (OneSource and eCare Online)
For the OneSource product, you will have the option to choose a single service type (i.e. surgical,
diagnostic x-ray, hospital inpatient, etc.) or a group of service types when submitting an eligibility
inquiry. The grouped responses will return benefits for all of service types associated with the group.
For example, Mental Health returns benefits such as Psychiatric, Psychotherapy, Psychiatric - In Patient,
and Psychiatric - Out Patient.

See Frequently Asked Questions

If a service type grouping is chosen, you will be billed the number of transactions we run to
compile the response. The available service type groups are listed below.

Coverage Type Groups	Type of Benefits Requested	Total Transactions Billed
Standard Benefit Grouping	Health Benefit Plan Coverage Hospital Mental Health	3
Inpatient Hosp Benefit Grouping	Medical Care Hospital	2
Outpatient Hosp Benefit Grouping	Health Benefit Plan Coverage Medical Care Diagnostic X-Ray Diagnostic Lab Hospital MRI/CAT Scan	6
Emergency Services Benefit Grouping	Hospital Emergency Services	2
Physician Benefit Grouping	Professional Physician Professional Physician Visit - Office	2

See Service Type Grouping Detail

Integrated Clients (IntelliSource and EDI)

Many of our integrated clients are unable to send specific service types, so Experian Health has implemented a
change in the way we process UHC eligibility transactions. In order to return a response that is comparable
to what you previously received with UHC, we will run multiple transactions using different service types
and combine them into one comprehensive response. We will request generic benefits, hospital benefits,
and mental health benefits and combine the responses into our new standard response.

Below is a comparison of the 4010 response, the new 5010 response without any additions, and the
5010 response compiled using multiple transactions.

UHC 4010 Response	UHC 5010 Response (No Additional Transactions)	New Standard Response Generic Response + Hospital Benefits + Mental Health Benefits (3 Transactions)

Ambulatory Service Center Facility
Ambulatory Surgery		Ambulatory Surgery
Anesthesia
Brand Name Drugs
	Chiropractic	Chiropractic
Dental	Dental	Dental
Diagnostic Lab
Diagnostic X-Ray
Durable Medical Equipment Purchase
Emergency Services	Emergency Services	Emergency Services
General Benefits
Generic Drugs
Health Benefit Plan Coverage	Health Benefit Plan Coverage	Health Benefit Plan Coverage
Hospital	Hospital	Hospital
		Hospital - Emergency Accident
Hospital - Emergency Medical		Hospital - Emergency Medical
Hospital - Inpatient	Hospital - Inpatient	Hospital - Inpatient
Hospital - Outpatient	Hospital - Outpatient	Hospital - Outpatient
		Hospital - Room and Board
Medical Care	Medical Care	Medical Care
	Mental Health	Mental Health
Other Medical
Pharmacy	Pharmacy	Pharmacy
Physical Medicine
Professional Physician
Professional Physician Visit - Office	Professional Physician Visit - Office	Professional Physician Visit - Office
Psychiatric		Psychiatric
Psychiatric - In Patient		Psychiatric - In Patient
Psychiatric - Out Patient		Psychiatric - Out Patient
Psychotherapy		Psychotherapy
Routine Physical
Surgical
	Urgent Care	Urgent Care
Vision	Vision	Vision
Well Baby

Integrated Clients (eCare NEXT, IntelliSource, EDI, & Nebo)
For clients that are unable to send a specific service type, we will send UHC the Standard Benefit Group which is column three in the table above. This benefit group is compiled by running three eligibility inquiries so you will be charged a total of 3 transactions. If this response doesn’t meet your needs, please contact our Customer Support Team at customer.support@experianhealth.com regarding other options for response customizations.

For inquiries regarding pricing, please contact your Sales Representative.