Blue Cross
Blue Shield of Rhode Island (Commercial) - Quick Reference, What You Need to Know...
Search Options
-
Previously, this payer supports two search options. Now, only a single
search option is used.
1. Subscriber ID, Patient
Last Name, Patient First Name, Patient Date of Birth, and Relationship
to Subscriber.
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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
-
This payer uses a single begin date for an
inquiry.
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This payer supports up to one year in the
past. Future dates up to the end of the current month
are supported. No date spans are allowed.
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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.
-
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, and Mental Health MH.
-
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 now returns service type codes for Chiropractic 33
and Vision Benefits AL
where applicable.
-
Secondary Payer Information for Medicare and corresponding Member
IDs are now returned on
some 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.