Response Data
Benefits
The following information is based on a generic Health Benefit Plan Coverage - 30 inquiry.
- The active coverage for the generic Health Benefit Plan Coverage service type is not being returned (EB*1**30). Instead, active coverage is based on Medical Benefits (EB*1**1). In other words, active coverage (EB01=1) for the generic Health Benefit Plan (EB03=30) is now returned using Medical Benefits (EB03=1).
- The country code is no longer supplied in the response. Previously, it was supplied in the (N4) segment.
- This payer now returns up to 10 service types when the generic Health Benefit Plan Coverage (EQ01=30) is requested
This includes active service types for the following service types. However, the service type for generic Health Benefit Plan Coverage 30, is not returned.
Medical Care 1
Chiropractic 33
Dental Care 35
Hospital 47
Emergency Services 86
Pharmacy 88
Professional Physician Office Visit 98
Vision (Optometry) AL
Mental Health MH
Urgent Care UC
- Members with limited benefits get a reduced set or benefits.
For example, BC+ Standard EE for Pregnant Woman returns only Medical Care 1 and Dental Care 35.
- The designation for other payers are have been changed from Other or Additional Payer (EB01=R) to Contact Following Entity for Eligibility or Benefit Information (EB01=U). The address provided is attached to the Subscriber (NM101=IL) but appears to be the address of the payer.