Document Name |
Last Modified |
Electronic Implementation Manual Introduction
(488KB, pdf) |
06/19/2006 |
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:
(33KB, pdf)
|
5/17/2010 |
ETR3 Header/Trailer Layout:
(7KB, pdf)
|
10/13/2005 |
ETR3 Header/Trailer Definitions:
(7KB, pdf)
|
|
ETR3 Data Dictionary:
(54KB, pdf)
|
|
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)
|
|
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)
|
|
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:
(398KB, pdf)
|
06/03/2008
|
Appendix L - Sample BCBSIL ID Card
(35KB, pdf) |
05/21/2009 |
| 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
(44KB, pdf) |
07/24/2008 |
| Appendix P - General Test Cycle Schedule/Scenerios |
|
General Test Cycle Schedule:
(66KB, pdf)
|
11/17/2005
|
General Test Cycle Scenerios:
(106KB, pdf)
|
02/12/2008
|
| 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 - Tech Specs |
|
Cover Sheet:
(27KB, pdf) |
10/13/2005
|
Tech Specs:
(382KB, pdf) |
04/22/2009 |
