The fastest way to conduct business with BCBSIL throughout the entire claims process is via Electronic Data Interchange (EDI) – the computer-to-computer transmission of standardized information. EDI transactions are often identified by numbers assigned by the American National Standards Institute (ANSI). Here are some examples:
- Eligibility & benefits inquiry/response (ANSI 270/271)
- Referrals, pre-certification and authorizations (ANSI 278)
- Electronic claim submission (also known as Electronic Media Claims, or EMC) [ANSI 837P (Professional) or ANSI 837I (Institutional)]
- Claim status request/response (ANSI 276/277)
- Claim payment via Electronic Funds Transfer (ANSI 835 EFT)
- Electronic Remittance Advice (ANSI 835 ERA), or delivery of claims payment information
Note: Online Eligibility & Benefits (270/271) and Claims Status (276/277) transactions may be conducted almost continuously, with the exception of Sunday, 8 p.m. to midnight, CT.*
*Non-routine downtime will be communicated via designated third party independent vendor websites at least one week in advance.
Establish a vendor connection. Some electronic transactions, such as EFT, may be set up directly with BCBSIL. For other EDI transactions, you will need to enlist the services of a third-party electronic business vendor, such as Availity®.
- Availity – To register with Availity or learn more about services available to BCBSIL providers, visit the Availity website, or call Availity Client Services at 800-AVAILITY (282-4548).
- Prior to conducting EDI transactions, you will need to confirm services are available and register with your selected vendor.
- In some cases there may be a fee for services. We encourage you to “shop around”!
- Follow standards and guidelines. When conducting EDI transactions, health care providers, billing agents and clearinghouses must follow Health Insurance Portability and Accountability Act (HIPAA) standards. It is your responsibility to obtain and follow EDI transaction standards specified within the current ANSI X12 837 – ANSI 5010 Technical Reports Type 3 (TR3). For details, refer to the X12 site.
- Electronic Funds Transfer (835 EFT)
- Electronic Remittance Advice (835 ERA)
- Revisions in-progress for the 270/271 and 276/277 Companion Guides. To request notification of when revisions are complete, email Electronic Commerce Services.
- To learn more about your electronic options at BCBSIL, visit our online Education and Reference Center for dates and times of upcoming Webinars and Workshops.
- If you have questions that cannot be answered by your clearinghouse or software vendor, you may email Electronic Commerce Services for assistance.
Verification of eligibility and/or or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage applicable on the date services were rendered.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.