Universal Health Care Group (Commercial) - Quick Reference, What You Need to Know...
Search Options
-
Previously, this payer supports two search options. Now, only a single
search option is used.
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
-
As before, this payer uses a single begin
date for an inquiry.
-
This payer supports up to six months in
the past. No future dates or date spans are allowed.
-
The inquiry date now references a Plan
Date – 291 (DTP01).
-
The response now returns the Plan Begin
Date – 346 (DTP01).
Previously, it returned the Plan Date – 291 (DTP01).
Response Data
Benefits
The following information is based on a
generic “Health Benefit Plan Coverage - 30” inquiry.
-
This
payer only responds to a generic “Health Benefit Plan Coverage - 30”
inquiry.
-
The
5010 response now returns multiple service type codes in the
eligibility benefit loop (EB03).
Previously, it returned Active/Inactive coverage for the Health
Benefit Plan Coverage (EB03 = 30).
-
The
5010 response now uses return Co-Insurance (EB01=A), Co-Payment
(EB01=B), Deductible (EB01=C),
and Out of Pocket/Stop Loss (EB01=G).
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.