1. Recipient ID.
2. Social Security Number and Date of Birth.
3. Last Name, First Name, Middle Name, and Social Security Number.
4. Last Name, First Name, Middle Name, and Date of Birth.
Dates
Response Data
Benefits
The following information is based on a generic “Health Benefit Plan Coverage - 30” inquiry.
The 5010 response now contains several new references. Specifically, the response now uses
references for Plan Number (REF01=18), Case Number (REF01=3H), Issue Number (REF01=IF), and
Plan Network ID (REF01=N6).
Some of these references may return different qualifiers. In one test case, the same reference
value (REF02) was returned, but with different qualifiers (REF01). Specifically, the same reference value
was provided as a Plan Number (REF01=18) and an Issue Number (REF01=IF). The meaning of this
reference value was unclear.
The 5010 response now returns multiple service type codes in the eligibility benefit loop (EB03).
The response now uses service type codes for Mental Health – MH and Urgent Care – UC.
Disclaimer
This document is not intended to identify every scenario that may be
presented in the payer response.