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Electronic Implementation Manual

These documents comprise the Implementation Manual given to Funds during an Illinois electronic implementation.

A comprehensive listing of all documents is contained in the Implementation Manual Table of Contents and Appendix Listing listed below.

Document Name
Last Modified
  Electronic Implementation Manual Introduction (93kb, pdf)
11/17/2005
  Appendix A - Sample Provider Cover Letter (5kb, pdf)
10/13/2005
  Appendix B - Solicited and Non-Solicited Providers (32kb, pdf)
04/20/2007
  Appendix C - Transmission File
 
ETR3 Layout: (43kb, pdf)
09/05/2008
 
ETR3 Header/Trailer Layout: (7kb, pdf)
10/13/2005
 
ETR3 Header/Trailer Definitions:  (7kb, pdf)
10/13/2005
 
ETR3 Data Dictionary: (54kb, pdf)
9/11/2008
 

ETR3 Record Field Population Example for Physician Claims: (86KB, pdf)

11/17/2005

ETR3 Field Population Example for Hospital
Claims:
 (88KB, pdf)

 11/17/2005

  Appendix D - Recalibration Worksheet Steps (21kb, pdf)
10/13/2005
  Appendix E - Coordination of Benefits (COB) Balancing Examples (11kb, pdf)
10/13/2005
  Appendix F - Disposition File
 

EDF2 Layout: (82KB, pdf)

 10/13/2005

EDF2 Header/Trailer Layout: (14KB, pdf)

 06/22/2006

EDF2 Header/Trailer Definitions: (17KB, pdf)

 06/22/2006

EDF2 Data Dictionary: (27KB, pdf)

 06/22/2006

EDF2 Field Population Example for Physician Claims: (92KB, pdf)

 11/17/2005

EDF2 Field Population Example for Hospital Claims: (91KB, pdf)

 11/17/2005

EDF2 Field Population Example for RFI  (pended) Claims: (81KB, pdf)

 11/17/2005

EDF2 Field Population Example for Rejected Claims: (84KB, pdf)

 11/17/2005

  Appendix G - Adjustments (178KB, pdf)

 06/22/2006

 
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)
11/17/2005
 
R03 Additional Payment Late Charge (Institutional w/Discount) EDF2 Field Population Example: (70KB, pdf)
11/17/2005
 
R05 Refund Request (Institutional w/Discount) EDF2 Field Population Example: (71KB, pdf)
11/17/2005
 

Partial Credit Adjustment (Institutional w/Discount) EDF2 Field Population Example: (73KB, pdf)

11/17/2005

Full Credit Adjustment (Institutional w/Discount)EDF2 Field Population Example 1:  (71KB, pdf)

 11/17/2005

Full Credit Adjustment (Institutional w/Discount)EDF2 Field Population Example 2: (71KB, pdf)

 11/17/2005

  Appendix H - Transmittal Options

Transmittal Procedures (224KB, pdf)

 11/06/2006

  Appendix I - BlueReview
 
        Cover Sheet: (26KB, pdf)

 10/13/2005

        BlueReview: (334KB, pdf)

 01/24/2006

 

Appendix J - Sample Member Communication Letter (62KB, pdf)

10/13/2005
  Appendix K - Membership File Layouts
 

BlueStar AEP Layout & Field Explanations: (41KB, pdf)

 09/18/2008

HIPAA 834 Benefit Enrollment/Maintenance Layout & Field Explanations: (297KB, pdf)

 10/13/2005

  Appendix L - Sample BCBSIL ID Card (100KB, pdf)
10/13/2005
  Appendix M - BARS (CL03) Record Layout & Field Explanations
 
        Layout: (53KB, pdf)

 09/05/08

        Field Definitions: (61KB, pdf)

 10/13/2005

  Appendix N - BlueGateway Layout (73KB, pdf)

 09/05/08

  Appendix O - Labor Shared Claims Processing Implementation Plan Section
Not Yet Available
  Appendix P - General Test Cycle Schedule/Scenerios

General Test Cycle Schedule: (66KB, pdf)

 11/17/2005

General Test Cycle Scenerios: (132KB, pdf)

 09/06/2006

  Appendix Q - Aged Claims Reports

    Electronic Weekly Aged Claims Report

BlueCard (BC) File Layout: (65KB, pdf)

 09/05/08

Illinois (IL) File Layout: (65KB, pdf)

09/05/08

File Layout Field Descriptions (IL & BC): (85KB, pdf)

 09/05/08

     Electronic Bi-Monthly Aged Claims Report

 

Header/Trailer Layout & Field Descriptions: (68KB, pdf)

 10/13/2005

File Layout: (63KB, pdf)

 10/13/2005

File Layout Field Descriptions: (58KB, pdf)

 10/13/2005

  Appendix R - Labor Bytes
          Cover Sheet: (27KB, pdf)

 10/13/2005

          Labor Bytes: (2553KB, pdf)
10/13/2005
 

 

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