BCBS of Wisconsin (Commercial) - Quick Reference, What You Need to Know...
Search Options
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No changes in search options or search criteria. However, the optional
field for Patient Sex was removed.
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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.
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No differences in the demographic information were identified. However,
the response presented this
information in all capital letters.
Dates
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Only the current date is used for an
inquiry.
Previously, this payer supported up to three years in the past and date
spans up to 90 days.
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Dates now reference a Plan Date – 291
(DTP01) and are returned in a range format.
Date references for Eligibility – 307, are not returned.
Response Data
Benefits
The following information is based on a
generic “Health Benefit Plan Coverage - 30” inquiry.
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This
payer now provides the Member’s Address for HMO and Medicare
Advantage responses.
(This is a valuable enhancement from the previous 4010 response).
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Response data is now provided for Urgent Care – UC.
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New
Group Numbers are presented on Medicare Supplements.
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Student and Handicap indicators are not returned.
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In
some cases, 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)
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.