BCBS of Kansas City (Commercial) - Quick Reference, What You Need to Know...
Search Options
-
No changes in search options or search criteria. However, the optional
field for Patient Sex was removed.
This payer now supports the following search options.
1. Subscriber ID, Patient
Last Name, Patient First Name, Patient Date of Birth, and Relationship
to Subscriber.
-
This payer does not promote dependent data. For this reason, it is
necessary for a transaction to use either
a subscriber or dependent loop, depending on the specified value of the
relationship code.
Dates
-
This payer requires both begin and end
dates for an inquiry.
-
This payer supports dates up to two years
in the past. Date spans up to 90-days are allowed.
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Dates up to 30-days in the future are also
allowed.
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Inquiry dates now reference a Plan Date
291 (DTP01).
-
The 5010 response returns an open-ended
date range for the Plan Date 291 (DTP01).
For example, the open-ended date may be presented as 20351231 or
99991231.
(2100C/D Loop, DTP01 Segment, with DTP03=RD8)
-
The 5010 response returns an additional
date range for Plan Date 291 (DTP01) in the
dependent loop. (2100D Loop, DTP01, with DTP03=RD8)
-
Note: The begin and end dates of service
are not returned
in the response for a Subscriber.
Response Data
Benefits
The following information is based on a
generic Health Benefit Plan Coverage - 30 inquiry.
-
The
response now returns the name of the payer as BLUE CROSS BLUE SHIELD
OF KANSAS CITY.
Previously, it was returned as BCBS OF KANSAS CITY (Abbreviated).
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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.
-
This
payer has stopped using the U designation for In Plan and Out of
Plan Network (EB12=U).
Now, they extensively use a W for both In Plan and Out of Plan
Network (EB12=W).
-
When
applicable, the response now returns Secondary Payer information.
(2120C Loop, NM1 Segment)
Disclaimer
This document is not intended to identify every scenario that may be
presented in the payer response.
It should
also be noted, that the payer response may vary depending on the search
criteria used in the initial inquiry.
Some content
is no longer returned in the X12 5010 271 response. In a similar fashion,
some content has been
modified and
new response information may be returned. Information that appeared
consistent between the
4010 and 5010
responses was not presented in this document.