Overview
When you submit a list of insurance payers to be added to the VOB module Payer Code List, Dazos works with the clearinghouse to confirm and map each payer to the correct payer code. There are a few important rules that govern how this mapping works — including how multiple insurance names can share a single code, how non-EDI payers are handled, and how Blue Cross Blue Shield (BCBS) plans are mapped.
Understanding these rules helps set the right expectations when requesting payer code additions and when running electronic eligibility verifications (VOBs).
Key Concepts
Payer codes are not always one-to-one. Multiple insurance names can share a single payer code.
Not all insurers support EDI. Some payers do not support electronic eligibility verification and must be verified manually.
BCBS plans have a general fallback code. General BCBS entries are mapped to a shared clearinghouse code, but state-specific codes are preferred when available.
How It Works
Multiple Insurance Names, One Payer Code
Many insurance names are variations of the same payer and share a single payer code in the clearinghouse. For example, all United Healthcare and Optum/UBH variations use payer code 00192 - United Healthcare. When a large list of insurances is submitted, it is common for the number of resulting payer codes to be significantly fewer than the number of insurance names — this is expected and correct.
Non-EDI Payers (Manual Verification Required)
Some insurance carriers do not support electronic eligibility verification (EDI). For these payers, no payer code can be added to the VOB Payer Code List, and benefits must be verified manually by calling the payer directly or logging into the payer's portal.
Examples of payers that do not support EDI include:
Advantek
Advantek Benefit Administrators
Adventist Health System
Community Care Health
Halcyon
Halcyon Behavioral
If a payer you submitted is not added to your Payer Code List, it is likely because the clearinghouse confirmed that the payer does not support electronic eligibility. In these cases, your team will need to verify benefits for those members manually.
BCBS Plans — General Mapping and Best Practice
General Blue Cross Blue Shield entries — including plans that are not specific to a state — are mapped by the clearinghouse to S001 - Blue Exchange. This code can be used to run eligibility for these plans.
Examples of BCBS entries that are typically mapped to S001 - Blue Exchange include:
Blue Cross Blue Shield
Blue Cross Blue Shield Federal
Blue Cross Blue Shield of California
Anthem Blue Cross Blue Shield of California (WellPoint)
Blue Shield (Halcyon)
However, the clearinghouse recommends running BCBS eligibility through the patient's local, state-specific BCBS payer whenever possible, rather than the general Blue Exchange code. Using the state-specific payer code typically returns more accurate and complete eligibility results.
Important Notes
Fewer payer codes than insurance names is normal. If you submit 54 insurance names and receive 30 payer codes, this is not an error — it reflects the clearinghouse's mapping of related insurance variations to shared codes.
Non-EDI payers cannot be added electronically. If a payer does not support EDI, there is no payer code to add. These payers will always require manual verification regardless of the platform.
Use state-specific BCBS codes when possible. While S001 - Blue Exchange works as a general fallback for BCBS plans, running eligibility through the patient's local BCBS payer code is the recommended best practice for more complete results.
💡 Need to add payers to your Payer Code List? Contact Dazos Support and provide a list of the insurance names you'd like added. Our team will work with the clearinghouse to confirm the correct payer codes and update your VOB module accordingly.