Blue Cross
Blue Shield of Nebraska (Commercial) - Quick Reference, What You Need to Know...
Search Options
-
Previously, two search options were used, one for Subscriber and one for
Dependent.
-
Now, only a single search option is supported and requires the selection
of the Relationship Code.
For this reason, it is necessary for the inquiry to use either a
subscriber or dependent loop, depending
on the specified value of the relationship code.
1. Subscriber ID, Patient
Last Name, Patient First Name, Patient Date of Birth, and Relationship
to Subscriber.
-
No differences in the demographic information were identified.
Dates
-
Inquiry dates now reference a Plan Date
291 (DTP01) and are returned in a range format.
-
Date references for Eligibility 307, are
not returned.
-
This payer supports up to two years in the
past and date spans up to 90 days. No future dates are allowed.
Response Data
Benefits
The following information is based on a
generic Health Benefit Plan Coverage - 30 inquiry.
This payer may support other service type codes.
-
Basically, no major restructuring of the response exists. However,
this payer has added service types
and cleaned up some of the message text as an improvement.
-
The
response now includes added service types and benefit information
for Chiropractic - 33,
Hospital Inpatient 48, Hospital Outpatient 50, Hospital
Emergency Medical 52, Pharmacy 88,
Professional Physician Office Visit 98, Physician Office Visit
Sick BY, Physicians Office Visit Well BZ,
Mental Health MH, and Urgent Care UC.
-
For
benefit description (EB*D), the text Benefit Amount: 0 is not
being sent.
In other words, the data is not codified.
-
For
some plans, benefit information is returned when the benefits are
the same for both an
In Plan and Out of Plan Network, or when a Plan Network benefit does
not apply.
This may occur regardless of the In Plan or Out of Plan Network
designation (EB12=W).
In other words, they use W for in and out of network on a few
plans.
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.