Blue Cross
Blue Shield of North Dakota (Commercial) - Quick Reference, What You Need to Know...
Search Options
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No changes in search options or search criteria. 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.
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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
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This payer requires the begin and end dates
for an inquiry.
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This payer supports dates up to 30 days in the
past and date spans up to 30 days.
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Future dates are also supported.
(Up to the last day of the current month when the current date occurs
between the 1st and the 15th.)
(Up to the last day of the following month when the current date occurs
after the 16th of the current month.)
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Inquiry dates now reference a Plan Date
291 (DTP01).
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The response now returns the Plan Date
291 (DTP01) in the 2100C/D Loop.
Previously, the Benefit Date 292 (DTP01)
was returned.
Response Data
Benefits
The following information is based on a
generic Health Benefit Plan Coverage - 30 inquiry.
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The 5010 response now returns multiple service type codes in the
eligibility benefit loop (EB03).
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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.
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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.