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July 27, 2015

BCBSKS Eligibility Editing

BCBSKS, payer ID 47163 will tighten eligibility editing August 17, 2015.

The purpose of BCBSKS tightening eligibility edits is to increase the eligibility match for the submitter and payer.  When the subscriber is the patient, editing will require a match of the subscriber ID to the last name, first name and date of birth. When the patient is not the subscriber, editing will require a match of the subscriber ID to the subscriber last name, first name of the patient and patient date of birth. 

Edit Code

Edit Logic

A7:505:IL

When subscriber is the patient: 2010BA-NM104, first character of the subscriber first name must match the ID number submitted in the 2010BA-NM109.

A7:505:QC

When patient is not the subscriber: 2010CA-NM104, first character of the patient first name must match the ID number submitted in the 2010BA-NM109.

A7:158:QC / A7:505:QC

When patient is not the subscriber: 2010CA NM-104, first character of the patient first name must match date of birth submitted in 2010CA-DMG02.

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