Rule changes for 270/271 transactions take effect December 16

On December 16, 2012, we are implementing changes to eligibility and benefit requests and responses (270/271 transactions) to comply with guidelines developed by the Committee on Operating Rules for Information Exchange (CORE*). Updates include:

Although updated CORE guidelines take effect on January 1, 2013, Blue Cross Blue Shield of Massachusetts is implementing them in advance. These changes build on existing standards to make electronic transactions more predictable and consistent.

Changes to Service Type Codes submitted with Service Type Code 30

Below is a summary of changes for a return of information submitted for an Eligibility/Benefit Inquiry (270) with Service Type Code 30 (Health Benefit Plan Coverage). To view the full Standard Service Type 30 response, please refer to our HIPAA Transaction 270/271 Companion Guide.

For this Service Type:

You'll notice this change starting December 16, 2012:

45 Hospital Benefits will be returned
51 Hospital - Emergency Accident
86 Emergency Services
98 Professional Physician Visit - Office Sick benefits will be returned
BY Physician Visit - Office: Sick Information will no longer be returned (it will be replaced by ST 98)

Additions to Service Type codes supported

Additional Service Types will now be supported. In some cases, the level of information returned for a specific Service Type on an Eligibility Benefit Response has changed. To view a full list of supported Service Types and Service Type Groupings, please refer to our HIPAA Transaction 270/271 Companion Guide.

Plan and benefit level deductible dates

Plan level and Benefit level deductible dates will be returned, when applicable. Please refer to our HIPAA Transaction 270/271 Companion Guide.

*A committee of the Council for Affordable Quality Healthcare (CAQH).