Fall 2009

Eligibility & Benefits transaction has new features

The Availity^®1 Health Information Network Eligibility and Benefits (E&B) transaction provides real-time benefit results such as coverage status, copay, deductible, coinsurance amounts, member data and some lower level benefits. E&B can assist providers by eliminating or reducing phone calls to health plans as well as providing quick access to other capabilities through Availity (i.e., CareProfile^®, CareCalc^®, CareCollect^sm).

Effective July 18, 2009, Blue Cross and Blue Shield of Florida, Inc. (BCBSF) began including the following enhancements to the E&B transaction.

• Additional out-of-network benefits — Availity will display out-of-network benefits for all BCBSF health plans when applicable. This includes out-of-network benefits when they are the same as in-network benefits.
• Suppressed individual deductible — To eliminate confusion as to when the individual deductible does not apply on a family plan, Availity will not display the individual deductible for family Health Savings Account (HSA) plans when the family deductible is the same. The individual information field for these plans will be suppressed by BCBSF.
• Consolidated other party liability — BCBSF will provide existing other party liability information to Availity. The consolidated information will be displayed on one screen.
• Display deductible and copay information on all service types — Availity will display the deductible and copayment on any applicable service type.