The fastest way to conduct business with BCBSOK throughout the entire claims process is via Electronic Data Interchange – 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)
- Prior authorizations and referrals (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
Getting Started
Establish a vendor connection. Some electronic transactions, such as EFT, may be set up directly with BCBSOK. For other EDI transactions, you will need to enlist the services of a third-party electronic business vendor, such as Availity® Essentials
- Availity Essentials – To register with Availity or learn more about services available to BCBSOK providers, visit Availity's website, or call Availity Client Services at 800-282-4548.
Reminders
- 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.
Online Transaction Schedule
Effective Jan. 1, 2013, 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.
Electronic Funds Transfer / Electronic Remittance Advice
EFT is a secure method of claims payment. BCBSOK electronically transfers funds directly into the bank account of your choice for added security and prompt payments. Learn more about EFT and ERA.
Resources
- To learn more about your electronic options at BCBSOK, 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.
Holiday Schedule Reminders
The reminders below are intended to assist providers in planning ahead for scheduling variances that may affect electronic claims (837) and/or electronic claims payment and remittance (835) transactions.