TexanPlus (Medicaid) - Quick Reference, What You Need to Know...
Includes TexanPlus North Texas and TexanPlus Southeast Texas.

Search Options

• No changes in search options or search criteria. As before, this payer supports the following search option.

1. Subscriber ID, Patient Last Name, Patient First Name, Patient Date of Birth, and Relationship to Subscriber.

• For successful transaction processing, dependent data may be promoted to the subscriber loop.

Dates

• This payer requires both begin and end dates for an inquiry.
• This payer supports dates up to three years in the past and up to a 90-day date span.
  No future dates are allowed.
• Inquiry dates now reference a Plan Date – 291 (DTP01).
• The 5010 response returns a Plan Date – 291 in both the 2100C and 2110C loops.

Response Data

Benefits
The following information is based on a generic “Health Benefit Plan Coverage - 30” inquiry.

• The 5010 response now returns the Identity Card Number using an “HJ” qualifier (REF01=HJ).
  Previously, in the 4010 transaction, the Family Unit Number qualifier, “49” was returned.
   

• The 5010 response now returns the PCP Name, Provider ID, and Address information (2120C Loop).
   

• The 5010 response now returns multiple service type codes in the eligibility benefit loop (EB03).

• The 5010 response now uses service type codes for Physician Office Visit Sick – BY,
  Physician Office Visit Well – BZ, Mental Health – MH, and Urgent Care – UC.