EDI Frequently Asked Questions
Do you require the taxonomy code to be reported on any of the 837 formats and, if so, which ones?
No.
Are there any circumstances where you might require providers to use NDC codes on the 837?
Yes. All applicable HCPCS and CPT codes should be submitted with an NDC number valid for the date of service.
When receiving claims in a batch mode, if one claim contains an error will just that claim reject or will you reject the entire batch?
We perform edits at the claim level. If there is a problem with one claim, we will return only the errored claim.
Carrier Codes:
- 400: BlueCross BlueShield State Health Plan
- 401: BlueCross BlueShield
- 402: FEP BlueCross
- 922: BlueChoice® HealthPlan
- C63: Medicare Advantage
The following carrier codes are for those TPAs that use the Preferred Blue® network and are also accepted electronically. The carrier code is used to route these claims to the appropriate area, so it is imperative to use the appropriate carrier code for TPA members' claims.
- 886: Planned Administrators, Inc. (PAI)
- 315: Thomas Cooper
With regard to Release of Information CLM09 and OI06, in your opinion is an "N" a legitimate code based on Privacy regulations? (i.e., will you accept "l?")
Based on privacy guidelines, it does not seem appropriate for a provider to file with an "N."
What forms do I need to complete to be able to send HIPAA transactions?
You must complete the Trading Partner Agreement and the EDIG Enrollment Form.
- If you represent a hospital, or are a doctor or other health care professional who will be transmitting transactions directly to us, you should complete these forms.
- If you are a clearinghouse, complete these forms.
I use a clearinghouse to process my transactions. Is there anything I need to do?
Clearinghouses must complete and sign the Trading Partner Agreement and EDIG Enrollment form.
If you plan to use a vendor or clearinghouse to conduct your HIPAA transactions, please have them contact us to ensure their transactions are compatible with our systems.
You still must meet the separate HIPAA Privacy rules that went into effect on April 14, 2003.
What if I am not ready to transmit HIPAA transactions?
If you need another method of filing claims to us, My Insurance ManagerSM is HIPAA compliant for institutional, professional and dental 837 claims filing.
You can also use My Insurance Manager for HIPAA-compliant eligibility and benefits information (270/271) and claims status inquiries (276/277).
Do you provide the 835 Electronic Remittance Advice?
Yes. You must complete the appropriate Trading Partner Agreement and Enrollment form. There is one for hospitals and health care professionals and another for clearinghouses. You can find these in the Provider Enrollment section of the website.
Will the 835 include line level payment information?
The remittance will match the reimbursement methodology. Inpatient remits will show claim level payments.
Outpatient and professional medical and dental remits will show line level payments.