1. Subscriber ID, Patient Last Name, Patient First Name, Patient Date of Birth, and Relationship to Subscriber.
2. Subscriber ID, Patient Last Name, Patient Date of Birth, and Relationship to Subscriber.
3. Subscriber ID, Patient Last Name, Patient First Name, and Relationship to Subscriber.
4. Subscriber ID, Patient Last Name, Patient First Name, and Relationship to Subscriber. (Blue Exchange)
5. Minnesota PMI (Person Master Index ID), Patient Date of Birth, and Relationship to Subscriber
Response Data
Benefits
The following information is based on a generic “Health Benefit Plan Coverage - 30” inquiry.
The new response now returns the BCBS MN Primary Policy Holder’s Identification Number
with the Family Member Code Suffix.The Member’s Address is now being returned.
The 5010 response now returns multiple service type codes in the eligibility benefit loop (EB03).
When applicable, the 5010 response now returns service type codes for Mental Health – MH
and Urgent Care – UC.The Primary Payer and Secondary Payer Names are returned if known.
The Contracted Service Provider for Pharmacy Benefits is now returned.
The Supplemental Plans Medicare ID is returned if known.
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).