Blue Cross Blue Shield Eligibility Check – Calendar Year and Service Year

A couple of things to pay attention to with BCBS when doing an initial eligibility check or follow up eligibility check.
Calendar Year vs Service Year
Calendar year – A time frame starting on January 1
Service year – A time frame that does not start on January 1.

Some plans will run on a calendar year, some will run on a service year, and some plans will run on both. It is extremely confusing but hopefully this provides a bit of insight so that it minimizes confusion. When doing an eligibility check, pay attention to both of these terms, calendar year and service year.
In the example below, the patient’s plan runs on a service year that starts on March 1 and ends on Feb 28. This means the deductible and Max OOP will not reset until March 1. If you scroll down and look at the benefits details, you will see the benefits run on a calendar year. What this means is that the patient’s benefits will reset on January 1. This can add a layer of confusion but once you understand how to identify these two things, it will make billing simpler and explaining it to the patient easier and clearer.
If you are using Simple Practice to manage your clinic, it is good practice to put these details into the Admin note of the patient’s record for future reference.
Plan Details:
Benefits Detail:
Sample Admin Note:

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