Healthcare Point-of-Service Transactions VeriFone® TRANZ® Terminals Transaction Guide Key Version AM 1.13 Arizona Physicians IPA (APIPA) Eligibility Overview Request This transaction allows you to verify a patient’s eligibility status and benefits for APIPA for a single date of service. Disclaimer: The provided information is not a guarantee of coverage. Actual benefits are determined only when the claim is received. Note, certain procedures may require pre-approval. Date of Service Restrictions • Any date on file. • If no date is entered, press <Enter> to send the current date of service. Special Considerations This payer accepts entry of the provider’s National Provider Identifier (NPI) or tax ID. To Enter Letters 1. Press the number key on which the letter appears. 2. Press <Alpha> once, twice, or three times, until the letter appears. 3. Special characters are on the * and # keys. Q and Z are on key 1. Other Usage Tips To print a list of transactions on each key, press <Func> then 2. February 13, 2014 Step: POS Display: Enter: 1 idle 2 payer menu 3 PROVIDER ID/TAX ID 4 MEMBER ID APIPA subscriber ID <Enter> 5 LAST NAME last name <Enter> 6 FIRST NAME first name <Enter> 7 DOB MMDDCCYY 8 SERVICE TYPE Service Type <Enter> See Service Types. 9 DOS MMDDYY date of service (mmddyy) <Enter> or just <Enter> for today’s date 4 (idle prompt AZV) 1 (APIPA) inquiring provider’s National Provider Identifier (NPI) or tax ID <Enter> (skips if defaulted) date of birth (mmddccyy) <Enter> Response The following section describes each section of information that your payer can return. Individual responses can vary in content. For a detailed dictionary of response data, see the POS v4 Standard Eligibility Response Dictionary. To reprint the last response, press <Func> then 1. Page 1 of 5 Customer Support – 800.333.0263 © 2014 Emdeon Business Services LLC. All Rights Reserved APIPA Eligibility Key Version AM 1.13 Input Information The information you entered in your request. APIPA Information Basic information about the transaction, such as: The Submit ID used for tracking Benefit Indicator: Y = Benefit information exists N = No benefit information exists P = Pending Medicare Indicator: NA = Unable to determine Medicare coverage Other Payer Indicator: NA = Unable to determine other payer coverage Information Source Information about the payer, such as primary ID and name. Information Source Contact Payer contact information. Information Receiver Information about the requesting provider, such as primary ID and name. Information Receiver Contact February 13, 2014 Eligibility or Benefit Details The eligibility and benefit sections give details about the patient’s eligibility status and other types of benefits. There can be several eligibility and benefit sections. Each section header describes the eligibility status or benefit type to which the section applies. Your response can include the following sections: • Active Coverage • Inactive • Benefit Disclaimer Note: A row of all dashes designates the beginning of another section of data of the same eligibility/benefit type as the preceding section. Information for each type of eligibility status or benefit section can include: Coverage type Service types1 Applicable dollar amount or percentage Insurance type2 Plan coverage information Benefit period Benefit quantity Authorization or certification required In-network indicator Product or service ID Procedure Modifiers Health care service delivery details Additional identifiers Benefit-specific eligibility dates Limitations Information used to determine eligibility Benefit-related entity and entity contact information Requesting provider contact information, such as phone numbers or email addresses. 1see 2see Subscriber Service Types (HIPAA) Insurance Types (HIPAA) Information about the subscriber. Includes: The transaction audit (trace) numbers and origins The subscriber’s primary ID Demographic information, such as name, date of birth, gender; returned when the subscriber is the patient Subscriber identification numbers other than the primary ID Eligibility or benefit dates. Dates can also appear in the Eligibility/Benefit section Page 2 of 5 Customer Support – 800.333.0263 © 2014 Emdeon Business Services LLC. All Rights Reserved APIPA Eligibility Key Version AM 1.13 February 13, 2014 Code 38 39 40 41 42 43 44 45 46 47 48 49 50 51 Service Types Code 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 30 32 33 34 35 36 37 Description Medical Care Surgical Consultation Diagnostic X-Ray Diagnostic Lab Radiation Therapy Anesthesia Surgical Assistance Other Medical Blood Charges Used Durable Medical Equipment Durable Medical Equipment Purchase Ambulatory Service Center Facility Renal Supplies in the Home Alternate Method Dialysis Chronic Renal Disease (CRD) Equipment Pre–Admission Testing Durable Medical Equipment Rental Pneumonia Vaccine Second Surgical Opinion Third Surgical Opinion Social Work Diagnostic Dental Periodontics Restorative Endodontics Maxillofacial Prosthetics (MFP) Adjunctive Dental Services Health Benefit Plan Coverage Plan Waiting Period Chiropractic Chiropractic Office Visits Dental Care Dental Crowns Dental Accident 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 Description Orthodontics Prosthodontics Oral Surgery Routine (Preventive) Dental Home Health Care Home Health Prescriptions Home Health Visits Hospice Respite Care Hospital Hospital – Inpatient Hospital – Room and Board Hospital – Outpatient Hospital – Emergency Accident Hospital – Emergency Medical Hospital – Ambulatory Surgical Long Term Care Major Medical Medically Related Transportation Air Transportation Cabulance Licensed Ambulance General Benefits In–vitro Fertilization MRI/CAT Scan Donor Procedures Acupuncture Newborn Care Pathology Smoking Cessation Well Baby Care Maternity Transplants Audiology Exam Inhalation Therapy Diagnostic Medical Private Duty Nursing Prosthetic Device Dialysis Otological Exam Chemotherapy Allergy Testing Page 3 of 5 Customer Support – 800.333.0263 © 2014 Emdeon Business Services LLC. All Rights Reserved APIPA Eligibility Key Version AM 1.13 Code 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 A0 A1 A2 A3 A4 A5 A6 A7 A8 A9 AA AB AC AD AE February 13, 2014 Description Immunizations Routine Physical Family Planning Infertility Abortion AIDS Emergency Services Cancer Pharmacy Free Standing Prescription Drug Mail Order Prescription Drug Brand Name Prescription Drug Generic Prescription Drug Podiatry Podiatry – Office Visits Podiatry – Nursing Home Visits Professional (Physician) Anesthesiologist Professional (Physician) Visit – Office Professional (Physician) Visit – Inpatient Professional (Physician) Visit – Outpatient Professional (Physician) Visit – Nursing Home Professional (Physician) Visit – Skilled Nursing Facility Professional (Physician) Visit – Home Psychiatric Psychiatric – Room and Board Psychotherapy Psychiatric – Inpatient Psychiatric – Outpatient Rehabilitation Rehabilitation – Room and Board Rehabilitation – Inpatient Rehabilitation – Outpatient Occupational Therapy Physical Medicine Code AF AG AH AI AJ AK AL AM AN AO AQ AR B1 B2 B3 BA BB BC BD BE BF BG BH BI BJ BK BL BM BN BP BQ BR BS BT BU BV BW BX Description Speech Therapy Skilled Nursing Care Skilled Nursing Care – Room and Board Substance Abuse Alcoholism Drug Addiction Vision (Optometry) Frames Routine Exam Lenses Nonmedically Necessary Physical Experimental Drug Therapy Burn Care Brand Name Prescription Drug - Formulary Brand Name Prescription Drug – Non-Formulary Independent Medical Evaluation Partial Hospitalization (Psychiatric) Day Care (Psychiatric) Cognitive Therapy Massage Therapy Pulmonary Rehabilitation Cardiac Rehabilitation Pediatric Nursery Skin Orthopedic Cardiac Lymphatic Gastrointestinal Endocrine Neurology Eye Invasive Procedures Gynecological Obstetrical Obstetrical/ Gynecological Mail Order Prescription Drug: Brand Name Mail Order Prescription Drug: Generic Page 4 of 5 Customer Support – 800.333.0263 © 2014 Emdeon Business Services LLC. All Rights Reserved APIPA Eligibility Key Version AM 1.13 Code BY BZ C1 CA CB CC CD CE CF CG CH CI CJ CK CL CM CN CO CP CQ DG DM DS GF GN GY IC MH NI ON PT PU RN Description Physician Visit/Office: Sick Physician Visit/Office: Well Coronary Care Private Duty Nursing Inpatient Private Duty Nursing - Home Surgical Benefits Professional (Physician) Surgical Benefits - Facility Mental Health Provider Inpatient Mental Health Provider Outpatient Mental Health Facility Inpatient Mental Health Facility Outpatient Substance Abuse Facility Inpatient Substance Abuse Facility Outpatient Screening X-Ray Screening Laboratory Mammogram, high risk patient Mammogram, low risk patient Flu Vaccination Eyewear and Eyewear Accessories Case Management Dermatology Durable Medical Equipment Diabetic Supplies Generic Prescription Drug Formulary Generic Prescription Drug Non-Formulary Allergy Intensive Care Mental Health Neonatal Intensive Care Oncology Physical Therapy Pulmonary Renal February 13, 2014 Code RT TC TN UC Description Residential Psychiatric Treatment Transitional Care Transitional Nursery Care Urgent Care Error Messages Transaction-related error messages begin with CL, HT, or RH, followed by a number and a line or so of text. Most messages are self-explanatory. For a comprehensive description of all error messages, see the document Dictionary of Transaction Error Messages. Page 5 of 5 Customer Support – 800.333.0263 © 2014 Emdeon Business Services LLC. All Rights Reserved
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