MICRA-BEV™ Explainer · 04 of 05

The BH Carve-Out Problem — Solved

Step through the side-by-side comparison, or auto-play to watch both paths unfold simultaneously.

Scenario: Patient has Aetna medical plan — but BH benefits are carved out to Optum Behavioral Health
— / 5
Standard BEV Tool
Generic Clearinghouse
1
Query Aetna for BH Benefits

Standard tool sends EDI 270 to Aetna — the payer printed on the card — with Service Type Code 30 (Mental Health).

2
Aetna Returns "Not Covered"

Aetna's 271 response shows no mental health benefits under the medical plan.

271 Response:
SV1: STC=30 (Mental Health)
EB: I — Inactive/Not Covered
MSG: "BH benefits administered by separate entity"
3
Staff Assume No Coverage

The tool shows "no behavioral health coverage." Staff cancel, bill out-of-pocket, or spend 25 minutes calling Aetna.

Result: Denied Claim or Lost Revenue

Claim denied, patient billed incorrectly, staff time wasted. Revenue lost on every front.

MICRA-BEV™
BH-Specialized Engine
1
Query Aetna for BH Benefits

Same initial step — MICRA-BEV sends EDI 270 to Aetna with STC 30. Same request, same payer.

2
Detect Carve-Out Signal in 271

MICRA-BEV reads the MSG segment. Standard parsers ignore this. MICRA-BEV flags it as a carve-out.

271 Analysis:
MSG: "BH benefits administered by separate entity"
→ CARVE-OUT DETECTED
→ Auto-routing to Optum BH
3
Auto-Reroute EDI 270 → Optum BH

MICRA-BEV automatically submits a second EDI 270 to Optum Behavioral Health — the actual MH administrator.

4
Full BH Benefits Returned

Optum BH returns complete 271 with deductible, copay, coinsurance, session limits, telehealth parity.

Result: Clean Claim, First Pass

Correct payer, first submission. 99%+ first-pass rate. Accurate patient cost estimate. No denials.

14.2%
Avg BH Claim Denial Rate
99%+
MICRA-BEV First-Pass Rate