Blue Cross Blue Shield of Massachusetts (Commercial) - Quick Reference, What You Need to Know...
Search Options
-
This payer now supports three search options. Previously, only two
search options were available.
1. Subscriber ID, Patient
Last Name, Patient First Name, Patient Date of Birth, and Relationship
to Subscriber.
2. Subscriber ID, Patient Date of Birth, and Relationship to Subscriber.
3. 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 an inquiry to use
either a subscriber or dependent loop, depending on the specified value
of the relationship code.
Dates
-
A single begin date is used for an
inquiry. This payer supports past dates back 01/01/1800.
No future dates or date spans are allowed.
-
Dates now reference a Plan Date 291
(DTP01). Previously, date references for Eligibility 307 were used.
Response Data
Benefits
The following information is based on a
generic Health Benefit Plan Coverage - 30 inquiry. All other response
information appears unchanged or is similar to the previous response,
excepted as noted below.
-
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).
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.