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February 4, 2016

Blue KC Electronic Claim (837) Eligibility Edit Modification – Effective Monday, February 7, 2016

Blue Cross and Blue Shield of Kansas City (Blue KC) is making modifications to the eligibility edit implemented in January 2016.  The new edit will verify the patient date of birth and the subscriber ID matches Blue KC eligibility information.  All editing on the patient first name has been removed.  This update applies to all Blue KC lines of business except for BlueCard (ITS) and Federal Employee Program (FEP).

To ensure your claim complies with this edit update and does not reject, please make sure your claim contains the correct subscriber ID number supplied on the member ID card along with the correct date of birth for the patient.

Technical Overview

837 Claim Scenarios Edit Code Edit Logic

If the Dependent Loop is not present, the subscriber date of birth must match the member ID submitted.

A7:158:IL “Reject for Subscriber Date of Birth”

When the Dependent Loop is not present, the Subscriber Date of Birth (2010BA DMG02) must match the Subscriber ID submitted (2010BA NM109).

If the Dependent Loop is present, the date of birth of the patient must match the member ID submitted.

A7:158:QC “Reject for Dependent Date of Birth”

When the Dependent Loop is present, the Dependent Date of Birth (2010CA DMG02) must match the Subscriber ID number submitted (2010BA NM109).

 

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