Emdeon Vx570 User’s Guide
Chapter 4: Run Emdeon Transactions
© 2011 Emdeon Business Services LLC. All rights reserved.
Page 35
This material contains confidential, proprietary information. Unauthorized use or disclosure of the information is strictly prohibited.
Emdeon
®
---------- Emdeon Point Of Service ------
----
TEST.800
11/15/06 - 11:59:36
------------- Input Information ---------
----
Provider ID
123456789
Member ID
87654321
Begin DOS
11-15-06
End DOS
11-15-06
---------- ABC Insurance Eligibility ----
----
Submit ID
Time
Benefit Ind
Medicare Ind
Other Payer Ind
------------- Information Source --------
----
Primary ID
12345
Name ABC
Insurance
----------- Information Receiver --------
----
Primary ID
123456789
Name
Dr. Smith
---------------- Subscriber -----------
------
Trce1
123456789
ABCIns
Trce2
555666777889
9EMDEONMFX
Primary ID
87654321
Last
PATIENT
First
JANE
Middle
S
DOB
01/01/1080
Gender
Female
Cnge
N
Elig:
Program ID
Transaction date and time
Information you entered in the
request
Response details
End of response