Vermont (Medicaid) - Quick Reference, What You Need to Know...
Search Options
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Basically, there are no changes in search options or search criteria.
This payer provides only a single search option.
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For successful transaction processing, dependent data may be promoted to
the subscriber loop.
Dates
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Basically, there are no changes in date
rules.
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This payer supports up to three years in
the past, and future dates up to the last day of the
current month. There are no restrictions on date spans.
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Inquiry dates now reference a Plan Date –
291 (DTP01), rather than a Service Date - 472.
Response Data
Benefits
The following information is based on a
generic “Health Benefit Plan Coverage - 30” inquiry.
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By
default, a generic “Health Benefit Plan Coverage - 30” is used for
the inquiry.
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The
5010 response now uses service type codes for Urgent Care – UC, and
Mental Health – MH.
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The
5010 response now returns multiple service type codes in the
eligibility benefit loop (EB03).
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When
applicable, the response now returns service type for Physical
Therapy – PT.
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The
response now returns limitations when Visual Exam benefits have been
exhausted.
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The
response now uses message segments for eligibility of Additional
Programs.
For example, when a woman is eligible for her first cancer screening
program.
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.