We’ve enhanced Benefit Explainer in several important ways

On Nov. 1, 2021, Blue Cross Blue Shield of Michigan will launch some new features on Benefit Explainer.

If a benefit package ID or contract number doesn’t have complete benefits loaded, users will now see a message under the Benefit Package Report tab. The message informs users that there are pending benefit loads and they should check back later. It will appear in red font in the middle of the report screen. Once benefit loads are completed, the message will be removed and no longer will be displayed.

The message looks like this:

Users will also now see two new “payability limitations” in the Medical/Payment Policy and Benefit Package Report tabs. The limitations are:

• National Drug Code — This is a unique 10 or 11 digit, three-segment number, and a universal product identifier for human drugs in the U.S.
• Place of Service — This is a Health Insurance Portability and Accountability Act-compliant, two-digit code placed on health care claims to indicate the setting in which a service was provided.

The new limitations can appear as a stand-alone rule or as a combination rule with another limitation. They can appear in any of the following fields:

• Coverage Limitations
• Medical
• Benefit Limitations
• Provider Payment Limitations
• Authorization Assignment
• Member Cost Share
• Maximums
• Cost Sharing
• Accumulator and Counted Events

Here are a few screenshots of how this will look:

When a user clicks on the link in the Place of Service column, Benefit Explainer will open a new tab. In the new tab, the user can view the two-digit, HIPAA-compliant codes.

Note: Screenshots are for illustrative purposes only and may not represent actual data.