BMC Healthnet Plan (Commercial) - Quick Reference, What You Need to Know...
Search Options
-
No changes in search options or search criteria. This payer now supports
the following search options.
1. Recipient ID.
2. Last Name, First Name, Date of Birth, and
Sex.
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For successful transaction processing, dependent data may be promoted to
the subscriber loop.
Dates
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As before, this payer uses a single begin
date for an inquiry.
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This payer supports dates up to 13 months
in the past. No future dates or date spans are allowed.
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Inquiry dates now reference a Plan Date –
291 (DTP01).
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The 5010 response now returns a Plan Date
– 291 (DTP01) in 2110C loop.
The Eligibility Date - 307 (DTP01) in the 2100C loop is no longer
returned.
Response Data
Benefits
The following information is based on a
generic “Health Benefit Plan Coverage - 30” inquiry.
-
The
response now returns the Co-Payment and Benefit Description for
multiple Service Type Codes.
Previously only returned Active/Inactive for EB03= 30 (Health
Benefit Plan Coverage)
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The
5010 response now returns the Subscriber's Address in of 2100C N3
and N4 segments.
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The response now returns the Group Number and Group Name in a reference segment.
(2100C,
REF01=6P)
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The
response returns the Health Care Provider's Taxonomy Code for
Primary Care Physician.
(2120C, PRV Segment).
-
The
Address and Contact information for a PCP is no longer returned.
(2120C, PER Segment).
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.