BCBSM EDI Testing Requirements For The Specific Bill Type
BCBSM EDI Testing (Blue Cross Blue Shield of Michigan) steps should be done before you will start sending and receiving information electronically. BCBSM EDI Testing files must follow the 837/835 TR3’s and companion document requirements for the specific bill type.
BCBSM EDI Testing – Professional
Claim files must contain de-identified data with different claims and subscriber information. Must at the very least test for BCBSM claims. Claim types/specialty should represent types of claims submitted in the current production environment. File must contain claims where the Patient is the Subscriber for each line of business. File must contain claims where the Patient is not the subscriber for each line of business.
A test file with a minimum of 15 valid claims for whichever line of business is being tested:
- Blue Cross Blue Shield
- BCN/BCN Advantage
- FEP
- Medicare Plus Blue
- Supplemental (where the secondary claim is either a BCBSM, FEP or BCN claim and Medicare is the primary claim)
- Coordination of benefits
- Medicare B
- Medicaid
- Commercial.
BCBSM EDI Testing – Institutional
Claim files must contain de-identified data with different claims and subscriber information. Must at the very least test for BCBSM claims. Claim types/specialty should represent types of claims submitted in the current production environment. File must contain claims where the patient is the subscriber. File must contain claims where the patient is not the subscriber.
Test file with a minimum of 15 valid claims for whichever line of business is being tested:
- Blue Cross Blue Shield
- BCN/BCN Advantage
- FEP
- Medicare Plus Blue
- Supplemental (where the secondary claim is either a BCBSM, FEP or BCN claim and Medicare is the primary claim)
- Coordination of benefits
- Medicare A
- Medicaid.
BCBSM EDI Testing – Dental
Claim files must contain de-identified data with different claims and subscriber information. Claim types/specialty should represent types of claims submitted in the current production environment. File must contain claims where the Patient is the Subscriber. File must contain claims where the patient is not the subscriber.
Test file with a minimum of 15 valid claims for whichever line of business is being tested:
- Blue Cross Blue Shield
- BCN/BCN Advantage.