Blue Exchange will be the new enhanced version of the BCBS Interplan Teleprocessing Services(ITS). Blue Exchange is to be HIPAA compliant ITS with some new transactions added. There are 44 BCBS affiliates that participate in ITS with a combined membership of 81 million lives covered.
Regards, David Frenkel Business Development GEFEG USA Global Leader in Ecommerce Tools www.gefeg.com 425-260-5030 -----Original Message----- From: Rachel Foerster [mailto:[EMAIL PROTECTED]] Sent: Tuesday, April 30, 2002 12:31 PM To: 'WEDi/SNIP ID & Routing' Subject: RE: Searching on Blue Cross Blue Shield Association Plan Code Before you get too wedded to determining BCBS plan codes and then modeling a solution to them -- and just for the heck of it -- I checked my health card issued by Cigna for the POS plan. It contains an account number, issuer code of some sort and an ID which I conclude identifies me as the member. Additionally, if I'm not mistaken, when an individual covered by a BSBC plan obtains health care the provider submits the claim to their local BCBS plan. If the claim is covered by another BCBS company, that claim is transferred to the another BCBS company via the BlueExchange - a private network for the Blues. Rachel Rachel Foerster Principal Rachel Foerster & Associates, Ltd. Professionals in EDI & Electronic Commerce 39432 North Avenue Beach Park, IL 60099 Phone: 847-872-8070 Fax: 847-872-6860 http://www.rfa-edi.com -----Original Message----- From: William J. Kammerer [mailto:[EMAIL PROTECTED]] Sent: Tuesday, April 30, 2002 10:44 AM To: 'WEDi/SNIP ID & Routing' Subject: Searching on Blue Cross Blue Shield Association Plan Code A correspondent has confirmed that the most powerful ID for identifying BC/BS entities is the Plan Code. He said it was used in several inter-plan claims exchange systems and is universally used by all Blue plans on membership cards. Which is true enough, considering my own Anthem card shows plan codes of 332/834 (Institutional vs. Professional) on the front. Now it seems reasonable that my doctor ("shorthand" for saying his staff, software, billing agent or Clearinghouse - let's not get pedantic here) could take the "834" and look up Anthem's electronic Partner Profile (CPP) in the Healthcare Registry to see where to send claims or eligibility inquiries. Obviously, "834" by itself doesn't mean much - it has to be qualified by some code to say that it is a Blue Cross Blue Shield Association Plan Code (in both the CPP and the Registry search key). The first place to look for such qualifiers would be the X12 ISA Interchange ID Qualifier - even though the BC/BS Plan Code is obviously not a HIPAA compliant ISA receiver ID. Such an animal doesn't appear there, but D.E. 66 - Identification Code Qualifier - used in the NM1 does have code value AD meaning "Blue Cross Blue Shield Association Plan Code." So the Registry search key could be shown (stylized) as something like 66:AD:834 (meaning D.E. 66 code value AD qualifies value 834) which could be used to locate Anthem's CPP (assuming Anthem placed a list of all their associated plan codes in their CPP: 160 and 660 for Kentucky, 130 and 630 for Indiana, and 332 and 834 for Ohio). There's no reason the Healthcare CPP parts which specify Delivery Channels could not account for all plans using the same or different EDI portals, depending on Anthem's preferences. I'll leave the details for defining this stuff in the CPP to the volunteers who are authoring the "Elements of the Healthcare CPP" working paper (Marcelee Jackson, Dave Minch, Dick Brooks and Chris Feahr). Other persons familiar with BC/BS have mentioned in the past some mumbo-jumbo about how claims are submitted to the BC/BS home office where the provider is located, which in turn forwards the claims to the BC/BS of the patient. Was that done merely as a convenience to providers? And would it still be advantageous now that EDI portals of the particular patient's BC/BS could easily be located for direct submission? William J. Kammerer Novannet, LLC. +1 (614) 487-0320
