Virginia
(Medicaid) - Quick Reference, What You Need to Know...
Search Options
- No
changes in search options or search criteria.
- For
successful transaction processing, dependent data may be promoted to the
subscriber loop.
Dates
-
No changes in date criteria.
-
This payer supports, up to one year in the
past, up to five days in the future, and date spans within the same
month.
-
Under 5010, inquiry dates now reference a
Plan Date - 291 (DTP01).
Response Data
Benefits
The following information is based on a
generic “Health Benefit Plan Coverage - 30” inquiry.
-
Benefit information returned appears identical to the previous 4010
response.
-
In a couple of test cases, the data returned for the “Other or
Additional Payers” loop was poorly constructed (EB01=R). This payer
now specifies a designation which is intended for use when a
“National Unique Individual ID” has been mandated. Specifically, in
the 2120 loop, where the NM108 qualifier is set to “II.” Previous
responses used a “ZZ” qualifier.
When this information is returned, the payer provides a Member ID
when the name is “Medicare,” and the Member ID returned is always
valued as “00001.” This Member ID value is the same for both 4010
and 5010 responses with the only change being the qualifier that is
used. It is unclear why this change was implemented.
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.