Document Name |
Last Modified |
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Electronic Implementation Manual Introduction (93kb, pdf) |
11/17/2005 |
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Appendix A - Sample Provider Cover Letter (5kb, pdf) |
10/13/2005 |
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Appendix B - Solicited and Non-Solicited Providers (32kb, pdf) |
04/20/2007 |
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Appendix C - Transmission File |
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ETR3 Layout: (43kb, pdf)
|
09/05/2008 |
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ETR3 Header/Trailer Layout: (7kb, pdf)
|
10/13/2005 |
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ETR3 Header/Trailer Definitions: (7kb, pdf)
|
|
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ETR3 Data Dictionary: (54kb, pdf)
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|
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ETR3 Record Field Population Example for Physician Claims: (86KB, pdf)
|
11/17/2005 |
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ETR3 Field Population Example for Hospital
Claims: (88KB, pdf)
|
11/17/2005
|
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Appendix D - Recalibration Worksheet Steps (21kb, pdf) |
10/13/2005 |
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Appendix E - Coordination of Benefits (COB) Balancing Examples (11kb, pdf) |
10/13/2005 |
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Appendix F - Disposition File |
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EDF2 Layout: (82KB, pdf)
|
10/13/2005
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EDF2 Header/Trailer Layout: (14KB, pdf)
|
06/22/2006
|
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EDF2 Header/Trailer Definitions: (17KB, pdf)
|
06/22/2006
|
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EDF2 Data Dictionary: (27KB, pdf)
|
06/22/2006
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EDF2 Field Population Example for Physician Claims: (92KB, pdf)
|
11/17/2005
|
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EDF2 Field Population Example for Hospital Claims: (91KB, pdf)
|
11/17/2005
|
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EDF2 Field Population Example for RFI (pended) Claims: (81KB, pdf)
|
11/17/2005
|
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EDF2 Field Population Example for Rejected Claims: (84KB, pdf)
|
11/17/2005
|
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Appendix G - Adjustments (178KB, pdf) |
06/22/2006
|
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R03 Additional Payment (Professional w/Discount) EDF2 Field Population Example: (74KB, pdf)
|
11/17/2005 |
| |
R03 Additional Payment (Institutional w/Discount) EDF2 Field Population Example: (74KB, pdf)
|
|
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R03 Additional Payment Late Charge (Institutional w/Discount) EDF2 Field Population Example: (70KB, pdf)
|
11/17/2005 |
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R05 Refund Request (Institutional w/Discount) EDF2 Field Population Example: (71KB, pdf)
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|
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Partial Credit Adjustment (Institutional w/Discount) EDF2 Field Population Example: (73KB, pdf)
|
11/17/2005 |
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Full Credit Adjustment (Institutional w/Discount)EDF2 Field Population Example 1: (71KB, pdf)
|
11/17/2005
|
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Full Credit Adjustment (Institutional w/Discount)EDF2 Field Population Example 2: (71KB, pdf)
|
11/17/2005
|
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Appendix H - Transmittal Options |
|
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Transmittal Procedures (224KB, pdf)
|
11/06/2006
|
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Appendix I - BlueReview |
|
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Cover Sheet: (26KB, pdf) |
10/13/2005
|
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BlueReview: (334KB, pdf) |
01/24/2006
|
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Appendix J - Sample Member Communication Letter (62KB, pdf)
|
10/13/2005 |
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Appendix K - Membership File Layouts |
|
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BlueStar AEP Layout & Field Explanations: (41KB, pdf)
|
09/18/2008
|
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HIPAA 834 Benefit Enrollment/Maintenance Layout & Field Explanations: (297KB, pdf)
|
10/13/2005
|
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Appendix L - Sample BCBSIL ID Card (100KB, pdf) |
10/13/2005 |
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Appendix M - BARS (CL03) Record Layout & Field Explanations |
|
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Layout: (53KB, pdf) |
09/05/08
|
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Field Definitions: (61KB, pdf) |
10/13/2005
|
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Appendix N - BlueGateway Layout (73KB, pdf) |
09/05/08
|
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Appendix O - Labor Shared Claims Processing Implementation Plan Section |
Not Yet Available |
| |
Appendix P - General Test Cycle Schedule/Scenerios |
|
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General Test Cycle Schedule: (66KB, pdf)
|
11/17/2005
|
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General Test Cycle Scenerios: (132KB, pdf)
|
09/06/2006
|
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Appendix Q - Aged Claims Reports |
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Electronic Weekly Aged Claims Report
|
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BlueCard (BC) File Layout: (65KB, pdf)
|
09/05/08
|
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Illinois (IL) File Layout: (65KB, pdf)
|
09/05/08
|
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File Layout Field Descriptions (IL & BC): (85KB, pdf)
|
09/05/08
|
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Electronic Bi-Monthly Aged Claims Report
|
|
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Header/Trailer Layout & Field Descriptions: (68KB, pdf)
|
10/13/2005
|
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File Layout: (63KB, pdf)
|
10/13/2005
|
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File Layout Field Descriptions: (58KB, pdf)
|
10/13/2005
|
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Appendix R - Labor Bytes |
|
| |
Cover Sheet: (27KB, pdf) |
10/13/2005
|
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Labor Bytes: (2553KB, pdf) |
10/13/2005 |
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