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barek2k2/eligibility response from apex

Created June 16, 2020 14:30
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eligibility response from apex
<s:Envelope xmlns:s="http://schemas.xmlsoap.org/soap/envelope/">
<s:Body>
<SubmitEligibilityRequestResponse xmlns="http://tempuri.org/">
<SubmitEligibilityRequestResult
xmlns:a="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts.Eligibility"
xmlns:i="http://www.w3.org/2001/XMLSchema-instance">
<a:ErrorResponses
xmlns:b="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts.Eligibility.Response"/>
<a:InterchangeStatuses
xmlns:b="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts.Eligibility.Response"/>
<a:RequestId>41169</a:RequestId>
<a:Responses
xmlns:b="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts.Eligibility.Response">
<b:WsBenefitResponse>
<CreateDate xmlns="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts">
2020-06-15T14:09:49.647Z
</CreateDate>
<DocumentId i:nil="true" xmlns="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts"/>
<ResponseType xmlns="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts">
BenefitResponse
</ResponseType>
<b:BenefitFormat>DataModel</b:BenefitFormat>
<b:EnvelopeErrors i:nil="true"/>
<b:GroupControlNumber i:nil="true"/>
<b:Payers>
<b:WsEligibilityResponsePayer>
<b:CmsPlanId i:nil="true"/>
<b:CommonName>Medicaid - Optum</b:CommonName>
<b:Contacts i:nil="true"/>
<b:ElectronicTransmitterIdNumber i:nil="true"/>
<b:EmployersIdNumber i:nil="true"/>
<b:EntityType>Organization</b:EntityType>
<b:Errors i:nil="true"/>
<b:FirstName i:nil="true"/>
<b:MiddleName i:nil="true"/>
<b:NaicId i:nil="true"/>
<b:NationalPayerIdNumber i:nil="true"/>
<b:NationalProviderId i:nil="true"/>
<b:Payees>
<b:WsEligibilityResponsePayee>
<b:CmsPlanId i:nil="true"/>
<b:CommonName>Greene</b:CommonName>
<b:ContractNumber i:nil="true"/>
<b:DevicePin i:nil="true"/>
<b:EmployersIdNumber i:nil="true"/>
<b:EntityType>Individual</b:EntityType>
<b:Errors i:nil="true"/>
<b:FacilityIdNumber i:nil="true"/>
<b:FacilityNetworkIdNumber i:nil="true"/>
<b:FirstName>Don</b:FirstName>
<b:MedicaidProviderNumber i:nil="true"/>
<b:MedicareProviderNumber i:nil="true"/>
<b:MiddleName i:nil="true"/>
<b:NationalProviderId>1508971276</b:NationalProviderId>
<b:PayerId i:nil="true"/>
<b:PersonalIdNumber i:nil="true"/>
<b:PharmacyNumber i:nil="true"/>
<b:PhysicalAddress i:nil="true"
xmlns:c="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts"/>
<b:PriorIdNumber i:nil="true"/>
<b:ProviderPlanNetworkId i:nil="true"/>
<b:ProviderRole i:nil="true"/>
<b:ReceivingProviderTaxonomyCode i:nil="true"/>
<b:ServiceProviderNumber i:nil="true"/>
<b:SocialSecurityNumber i:nil="true"/>
<b:StateIssuingLicense i:nil="true"/>
<b:StateLicenseNumber i:nil="true"/>
<b:SubmitterIdNumber i:nil="true"/>
<b:Subscribers>
<b:WsEligibilityResponseSubscriber>
<b:AdmissionDate i:nil="true"/>
<b:AgencyClaimNumber i:nil="true"/>
<b:Benefits>
<b:WsBenefitInformation>
<b:AdditionalInformation i:nil="true"/>
<b:AdmissionDate i:nil="true"/>
<b:AlternativeListId i:nil="true"/>
<b:AuthenticationOrCertificationRequired i:nil="true"/>
<b:BenefitAmount>1000.00</b:BenefitAmount>
<b:BenefitDates i:nil="true"
xmlns:c="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts"/>
<b:BenefitEntities i:nil="true"/>
<b:BenefitQuantity i:nil="true"/>
<b:BenefitTimePeriod i:nil="true"/>
<b:CobDate i:nil="true"/>
<b:CompletionDate i:nil="true"/>
<b:CoverageListId i:nil="true"/>
<b:DateAdded i:nil="true"/>
<b:DeliverySchedules i:nil="true"/>
<b:DischargeDate i:nil="true"/>
<b:DrugFormularyNumber i:nil="true"/>
<b:EligibilityDates i:nil="true"
xmlns:c="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts"/>
<b:Errors i:nil="true"/>
<b:GroupNumber i:nil="true"/>
<b:GroupOrPolicyNumber i:nil="true"/>
<b:HealthInsuranceClaimNumber i:nil="true"/>
<b:LastUpdateDate i:nil="true"/>
<b:LatestVisitDate i:nil="true"/>
<b:LevelOfCoverage i:nil="true"/>
<b:MedicaidAssistanceCategory i:nil="true"/>
<b:MedicaidRecipientId i:nil="true"/>
<b:MemberId i:nil="true"/>
<b:MemberIdSuffix i:nil="true"/>
<b:Messages xmlns:c="http://schemas.microsoft.com/2003/10/Serialization/Arrays">
<c:string>UNLESS OTHERWISE REQUIRED BY STATE LAW, THIS NOTICE IS NOT A GUARANTEE OF
PAYMENT. BENEFITS ARE SUBJECT TO ALL CONTRACT LIMITS AND THE MEMBER'S STATUS ON THE DATE
OF SERVICE. ACCUMULATED AMOUNTS SUCH AS DEDUCTIBLE MAY CHANGE AS ADDITIONAL CLAIMS ARE
PROCESSED.
</c:string>
<c:string>CLAIMS WILL BE PROCESSED ACCORDING TO BENEFIT AND MEMBERSHIP INFORMATION ON OUR
FILES AT THE TIME OF PROCESSING. THEREFORE THE INFORMATION CONTAINED WITHIN DOES NOT
GUARANTEE REIMBURSEMENT.
</c:string>
</b:Messages>
<b:PatientResponsibilityPercentage i:nil="true"/>
<b:PcpDate i:nil="true"/>
<b:PeriodDates i:nil="true"
xmlns:c="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts"/>
<b:PlaceOfService i:nil="true"/>
<b:PlanBeginDate i:nil="true"/>
<b:PlanCoverageDescription i:nil="true"/>
<b:PlanDate i:nil="true"/>
<b:PlanInNetwork i:nil="true"/>
<b:PlanNetworkIdNumber i:nil="true"/>
<b:PlanNumber i:nil="true"/>
<b:PlanOrGroupName i:nil="true"/>
<b:PolicyNumber i:nil="true"/>
<b:PriorAuthorizationNumber i:nil="true"/>
<b:Procedure i:nil="true"/>
<b:ReferralNumber i:nil="true"/>
<b:ServiceDate i:nil="true"/>
<b:StatusDate i:nil="true"/>
<b:Type>Unknown</b:Type>
<b:TypeOfInsurance i:nil="true"/>
<b:TypesOfService>
<a:WsServiceType>MedicalCare</a:WsServiceType>
<a:WsServiceType>MajorMedical</a:WsServiceType>
<a:WsServiceType>Pharmacy</a:WsServiceType>
<a:WsServiceType>ProfessionalPhysicianVisitOffice</a:WsServiceType>
</b:TypesOfService>
</b:WsBenefitInformation>
</b:Benefits>
<b:BirthDate>1956-05-22T00:00:00</b:BirthDate>
<b:CertificationDate i:nil="true"/>
<b:ClassOfContract/>
<b:ClearinghouseTraceNumber>
<a:Number>2203</a:Number>
<a:OriginatorId>9APEXEDI99</a:OriginatorId>
<a:OriginatorSecondaryId/>
</b:ClearinghouseTraceNumber>
<b:CobraDates
xmlns:c="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts">
<c:End i:nil="true"/>
<c:Start i:nil="true"/>
</b:CobraDates>
<b:CommonName>Adams</b:CommonName>
<b:ContractNumber i:nil="true"/>
<b:DateAdded i:nil="true"/>
<b:DateOfLastUpdate i:nil="true"/>
<b:DeathDate i:nil="true"/>
<b:DischargeDate i:nil="true"/>
<b:EffectiveDateOfChange i:nil="true"/>
<b:EligibilityCategory i:nil="true"/>
<b:EligibilityDate i:nil="true"/>
<b:EligibilityDates
xmlns:c="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts">
<c:End i:nil="true"/>
<c:Start i:nil="true"/>
</b:EligibilityDates>
<b:EnrollmentDate i:nil="true"/>
<b:Errors i:nil="true"/>
<b:FamilyUnitNumber i:nil="true"/>
<b:FirstName>Ben</b:FirstName>
<b:Gender>Male</b:Gender>
<b:GroupNumber i:nil="true"/>
<b:GroupOrPolicyNumber i:nil="true"/>
<b:HealthInsuranceClaimNumber i:nil="true"/>
<b:IdCardSerialNumber i:nil="true"/>
<b:IdentityCardNumber/>
<b:IsInsured>false</b:IsInsured>
<b:IssueDate i:nil="true"
xmlns:c="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts"/>
<b:IssueNumber i:nil="true"/>
<b:MedicaidRecipientId i:nil="true"/>
<b:MedicalRecordNumber i:nil="true"/>
<b:MemberId>1000</b:MemberId>
<b:MemberIdSuffix/>
<b:MiddleName i:nil="true"/>
<b:MilitaryService i:nil="true"/>
<b:MultipleBirthSequenceNumber i:nil="true"/>
<b:OriginalPrimaryId/>
<b:PatientAccountNumber i:nil="true"/>
<b:PayeeTraceNumber i:nil="true"/>
<b:PayerTraceNumber i:nil="true"/>
<b:PhysicalAddress i:nil="true"
xmlns:c="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts"/>
<b:PlanDate i:nil="true"
xmlns:c="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts"/>
<b:PlanDates xmlns:c="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts">
<c:End i:nil="true"/>
<c:Start i:nil="true"/>
</b:PlanDates>
<b:PlanNetworkIdNumber i:nil="true"/>
<b:PlanNumber i:nil="true"/>
<b:PlanOrGroupName/>
<b:PolicyDates
xmlns:c="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts">
<c:End i:nil="true"/>
<c:Start i:nil="true"/>
</b:PolicyDates>
<b:PolicyNumber i:nil="true"/>
<b:PremiumPaidDates
xmlns:c="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts">
<c:End i:nil="true"/>
<c:Start i:nil="true"/>
</b:PremiumPaidDates>
<b:PrimaryInformationChanged>false</b:PrimaryInformationChanged>
<b:ServiceDate i:nil="true"/>
<b:SocialSecurityNumber i:nil="true"/>
<b:StandardUniqueId/>
<b:StatusDate i:nil="true"/>
<b:Suffix i:nil="true"/>
<b:TaxonomyCode/>
<b:TaxonomyRole i:nil="true"/>
<b:CaseNumber i:nil="true"/>
<b:Dependents i:nil="true"/>
<b:EntityType i:nil="true"/>
</b:WsEligibilityResponseSubscriber>
</b:Subscribers>
<b:Suffix i:nil="true"/>
<b:TaxIdNumber>800739996</b:TaxIdNumber>
<b:Type>Provider</b:Type>
<b:UserId i:nil="true"/>
</b:WsEligibilityResponsePayee>
</b:Payees>
<b:PayerId>APX14114</b:PayerId>
<b:Suffix i:nil="true"/>
<b:TaxIdNumber i:nil="true"/>
<b:Type>Payer</b:Type>
</b:WsEligibilityResponsePayer>
</b:Payers>
<b:TradingPartnerId i:nil="true"/>
<b:X12Document i:nil="true"/>
</b:WsBenefitResponse>
</a:Responses>
<a:Status>ResultsComplete</a:Status>
<a:ValidationResults
xmlns:b="http://schemas.datacontract.org/2004/07/Apex.OneTouchWebserviceContracts.Eligibility.Response"/>
</SubmitEligibilityRequestResult>
</SubmitEligibilityRequestResponse>
</s:Body>
</s:Envelope>
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