Blue Cross
Blue Shield of Florida
(Commercial) - Quick Reference, What You Need to Know...
Search Options
- This
payer uses a single search option.
- The
optional Middle Name field is not used in the inquiry.
- The
Patient Sex is optional.
Dates
-
Previously, date spans were only allowed
within the current month.
-
Now, there are no restrictions on date
spans.
-
Up to two years in the past and up to one
year in the future are allowable.
-
The Policy Effective Date is not returned.
Dates now reference the Plan Date,
Plan Begin Date, and Plan End Date. The Plan Date uses a date range.
The Plan Begin Date and Plan End Date use standard date format.
Response Data
Benefits
The following information is based on a
generic “Health Benefit Plan Coverage - 30” inquiry.
Access is provided to participating physicians and hospitals only.
-
Psychiatric Inpatient and Psychiatric Outpatient is not returned.
-
The Primary Care Physician (PCP) has been moved in the response.
-
Some message text has been moved from Cost Containment to Active
Coverage
without a service type. As determined by the lack of a valid service
type code,
this should not be confused as having actual coverage.
-
Message text describing other insurance has been moved from Cost
Containment
to Other or Additional Payer.
-
New Co-Payment, Co-Insurance, and Deductibles are returned for
Chiropractic,
Physician Office Visit - Sick, Physician Office Visit - Well,
Hospital Emergency Medical,
Independent Medical Evaluation, and Urgent Care. This also replaces
some response messages.
-
When designated as Not Applicable, Co-Insurance, Co-Payment, and Out
of Pocket
information may not be returned for In Plan and Out of Plan
Networks.
Demographics
- The
Plan Number, Group Number, and the Plan Network Identification Number
are not returned. For example,
this may include some Reference Identifications for Medicare Advantage,
Strategic Outsourcing Inc.,
Health Options, and Hospice of Southwest Florida.
- No
differences were identified with respect to the Subscriber/Dependent
names or Subscriber IDs being returned.
- No
changes were observed in the use of the Patient Relationship Code.
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.