Blue Cross Blue Shield of Louisiana (Commercial) - Quick Reference, What You Need to Know...
Search Options
-
Previously, this payer supported two search options. Now, this payer
supports only a single search.
The Patient Sex is an optional field. This payer supports the following
search option.
1. Subscriber ID, Patient
Last Name, Patient First Name, 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
Dates
-
As before, this payer requires only the
begin date for an inquiry.
-
This payer supports dates up to two years
in the past and up to a 90-day date span.
No future dates are allowed.
-
Inquiry dates now reference a Plan Date
291 (DTP01).
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The 5010 response returns a Plan Date
291 with a Date Range (RD8).
-
The Eligibility Date 307 and Policy
Expiration Date 540 are no longer returned.
Response Data
Benefits
The following information is based on a
generic Health Benefit Plan Coverage - 30 inquiry.
-
The 5010 response now returns the Subscriber Name (2100C, NM1
Segment) for a
Dependent Responses.
-
The response now returns the Patient Address in the respective
transaction loop
(2100C or 2100D).
-
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).
-
The
5010 response for a Subscriber only returns Individual Deductibles.
(EB01=C and EB02=IND)
-
The
5010 response for a Dependent only returns Family Deductibles.
(EB01=C and EB02=FAM)
-
Previously, the 4010 response for Subscribers and Dependents
returned both
Individual and Family Deductibles.
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.