Other health insurance verification

This is a reminder that providers should be reviewing member eligibility for the presence of other health insurance (OHI) before providing services; Medi-Cal Managed Care is the payer of last resort. If a claim denial is received via 835 or paper remittance for OHI, providers are responsible for ensuring all applicable payment opportunities have been exhausted before disputing the claim denial.

Providers can identify a member with OHI through the following processes:

• Availity:*
  • Run an eligibility transaction and check the Payer Details
• Digital 835 transaction extract: 
  • Anthem Blue Cross will populate when available: 
    • 2100 NM1 Segment — Corrected Priority Payer Name
      • 2100 NM103 — OHI Carrier Name
      • 2100 NM103 — OHI Carrier Billing Address
    • 2100 NM1 Segment — Other Subscriber Name
      • 2100 NM103 and NM104 — Member Name
      • 2100 NM109 — Member OHI Policy Number
    • OHI Carrier ID paper EOP:
      • OHI Carrier Name, and OHI Billing Address are on the remittance. OHI will be listed as Other Carrier on the claim details section of the EOP directly above the Total Net Paid

If you have any questions or concerns, please contact your Provider Experience representative.