Blue Cross and Blue Shield of Kansas City (Blue KC) is adding a new eligibility edit to help ensure that electronic claims are submitted with the correct member name, member date of birth, and member ID number. The new eligibility edit applies to all Blue KC lines of business except for BlueCard (ITS) and Federal Employee Program (FEP).

To ensure your claim complies with this new edit and does not reject, please make sure your claim contains the correct member name and member ID number off the member ID card along with the correct date of birth.

Technical Overview–New Electronic Claim Edit:

• The new edit will look for a match not only on member ID, but also on the first 5 characters of the first name and date of birth of the Subscriber Level Loops 2000B / 2010BA and Patient Level Loops 2000C / 2010CA.
• Below are edit details depending how the Subscriber and Patient loops are sent on the electronic claim:
  • Subscriber only loop is present on claim–first 5 characters of the subscriber first name and date of birth must match the member ID number submitted.
  • Subscriber and Patient loop is present on claim–the subscriber and patient are the same on the claim…first 5 characters of the patient first name and date of birth must match the member ID number submitted.
  • Subscriber and Patient loop is present on claim–the subscriber and patient are NOT the same on the claim…first 5 characters of the patient first name and date of birth must match the member ID number submitted.

Electronic Claim Scenarios and Claim Reject Examples

If you have questions, please contact your Blue KC Provider Relations Representative