BCBS of Arkansas (Commercial) - Quick Reference, What You Need to Know...
Search Options
-
Previously, two search options were used, one for Subscriber and one for
Dependent.
-
Now, only a single search option is supported and requires the selection
of the Relationship Code.
For this reason, it is necessary for the inquiry to use either a
subscriber or dependent loop, depending
on the specified value of the relationship code.
-
In many cases, the payer response promotes Dependent data to the
Subscriber loop.
In other words, the Subscriber may not be returned when a Dependent
search is made.
This may affect every Blues Plan in the country. For example, a large
nationwide employer
such as Wal-Mart that is based in Arkansas.
-
No differences in the demographic information were identified.
Dates
-
Dates now reference a Plan Date 291
(DTP01) and are returned in a range format.
Date references for Eligibility 307, are not returned.
-
This payer supports up to two years in the
past and date spans up to 90 days.
No future dates are allowed.
Response Data
Benefits
The following information is based on a
generic Health Benefit Plan Coverage - 30 inquiry.
However, this payer may support all service type codes and may also
allow multiple service types using
a repetition separator.
-
Psychiatric Inpatient A7 and Psychiatric Outpatient A8 are not
returned.
-
The
response now includes benefit information for Chiropractic - 33,
Physicians Visit Office Sick - BY,
Physicians Visit Office Well - BZ, and Urgent Care UC.
-
Extensively, benefit information is returned when the benefits are
the same for both an In Plan and
Out of Plan Network, or when a Plan Network benefit does not apply.
This may occur regardless of
the In Plan or Out of Plan Network designation. (EB12=W)
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.