Blue Cross Blue Shield EDI: Getting Started Guidelines
Blue Cross Blue Shield EDI Guidelines described below will be useful for providers, facilities, software vendors or clearinghouses and will help you learn how to reduce costs and save time by sending and receiving Blue Cross Blue Shield EDI information.
Blue Cross Blue Shield EDI claims submission tool is:
- Easy to use, provides faster turn-around time and is more cost-effective
- An all-payer solution, supporting the electronic submission of professional claims (including vision and hearing) and facility, Medicare, Medicaid and commercial claims
- Additional benefits and features:
- No software to load or maintain
- Payer-specific edits decrease the rate of rejection for first-time claim submissions
- Claims can be sent to all electronic payers
- Responses and remittances available in one convenient location
- Familiar user interface mimics the UB 92 and CMS 1500 forms
- Quick and easy claims entry
- “Red box” editing to pinpoint errors
- Helpful advice on every page.
EDI, or electronic data interchange, is the paperless way to exchange information via computer. The information can be things like claims, electronic enrollment, patient eligibility and claims status transactions. In order to send and receive Blue Cross Blue Shield EDI, you’ll need to get set up and follow some guidelines.
You can submit directly through Blue Cross Blue Shield website. To assist you in your transition to electronic billing, Blue Cross Blue Shield developed the internet claim submission tool. This online tool is designed for providers who currently submit only paper claims. You’re eligible to use the internet claim submission tool if you have a valid Michigan provider code and currently don’t submit any claims electronically.
If you’ve decided to bill Blue Cross Blue Shield electronically using billing software you purchased from a vendor, you must:
- Call the EDI Help Desk at 1-800-542-0945 to get a submitter ID and instructions.
- Complete a Trading Partner Agreement once your billing software is installed and ready for use.
Developed your own electronic billing software? To become an approved submitter, you must meet Blue Cross Blue Shield testing requirements and complete some steps with the EDI help desk.
Software vendor, clearinghouse or service bureau
You must meet our testing requirements and follow these steps:
- Complete self-testing.
- After you’ve received three passed files for each line of business tested from EDI help desk, call the number on the test instruction letter to begin subsystem testing. If you haven’t received testing instructions, please contact the EDI helpdesk at 1-800-542-0945.
It’s easy to submit claims electronically with the Internet claims submission tool from Blue Cross Blue Shield of Michigan and Blue Care Network. If you’re still submitting paper claims, making the switch to electronic billing means faster payment, less rebilling and an easier way to track claims approvals.