Blue Cross Blue Shield of Alabama (Commercial) - Quick Reference, What You Need to Know...

Search Options

• No changes in search options or search criteria. This payer now supports the following search options.
  The patient's middle initial is optional.

1. Subscriber ID, Patient Last Name, Patient First Name, Patient Middle Initial, Patient Date of Birth, Patient Sex,
    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.
   
• As before, this payer requires the Provider’s designated Provider Type (2100B/PRV01).
  In most cases, either Hospital – H or Other Physician – OT, is used to designate the Provider Type.

Dates

• This payer requires only the begin date for an inquiry.
• This payer supports past dates back to 01/01/1800. No future dates or date spans are allowed.
• Previously, the payer allowed dates up to one year in the past.
• Inquiry dates now reference a Plan Date – 291 (DTP01). 
  Previously, an Eligibility Date - 307 (DTP01) was used.

Response Data

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

• The patient’s address is now returned in the Subscriber 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.

• 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).

• Managed Care Contact information is now returned in the 2120 loop instead of using a
  message (MSG) segment.

Other
This payer expects provider information in the NM103 and NM104 segments of the 2100B loop
to match the NM102 qualifier of the same loop. In other words, when NM102 = 1 (Person) both
the Provider’s First and Last Name should be sent in the NM103 and NM104 segments.
When the Provider’s First Name is not given, then the NM104 value may be set to “Unknown.”
Likewise, when the NM102 = 2 (Non-Person Entity), the NM104 value should not be populated.