The Health Insurance Portability and Accountability Act (HIPAA) is the federal regulation that requires the use of standard X12 transactions to report and inquire about health care services. If you use electronic transactions, you had to implement HIPAA 5010 by Jan. 1, 2012. After Jan. 1, 2012, version 4010A1 is no longer valid.
- 5010 Frequently Asked Questions
- 5010 Readiness Statement
- 5010 Trading Partner Migration Frequently Asked Questions
- 5010 Companion Guide
What's Changed for 5010
Companion Guide for 5010
Section A - EDI User Guide
Section B - Transaction Specific Companion Documents
Healthy Blue has transitioned into a strategic relationship with Availity to serve as our electronic data interchange (EDI) partner for all electronic data and transactions.
Availity is an independent company that administers the secure provider portal on behalf of BlueChoice HealthPlan. Effective immediately, providers, billing services and clearinghouses who are new to the EDI can register to exchange 27x self-service and 837 claims electronic transactions at https://www.availity.com.*
To register or manage account changes for electronic funds transfers (EFT) only, use the EnrollHub™, a CAQH Solution™ enrollment tool,* which is a secure electronic EFT registration platform. This tool eliminates the need for paper registration, reduces administrative time and costs, and allows you to register with multiple payers at one time. If you were previously registered to receive EFT only, you must register using EnrollHub to manage account changes. No other action is needed.
As of June 1, 2018, please now use Availity (https://www.availity.com)* to register and manage account changes for electronic remittance advices (835). If you were previously registered to receive the 835, you must register using Availity to manage account changes. No other action is needed. Manage suppression (turn-off) paper remittance vouchers here.*
Refer to this quick guide if you need help registering with Availity.*
The EDI Solutions Help Desk is available Mondays - Fridays from 8 a.m. to 4:30 p.m. EST.
- What is Electronic Data Interchange?
Electronic Data Interchange (EDI) allows providers to submit claims, retrieve remittance advices and retrieve claim file acknowledgements from their computer systems via modem and phone lines to the insurance carrier or clearinghouse.
- Why submit claims electronically?
- Electronic claims are not subject to postal delays.
- Claims may be transmitted 24 hours a day and seven days a week.
- Electronic claims are faster and more accurate.
- Electronic claims are acknowledged by BlueChoice HealthPlan through notification and error reports, which are placed in your electronic mailbox.
- Electronic remittance advice is offered to all electronic submitters. This provides a cost savings and allows the provider to post payments automatically.
- The EDI Solutions department is available Monday, Tuesday, Wednesday, Friday 8:00-11:30 a.m., 12:30-5:30 p.m. and Thursday 8:00-9:00 a.m., 10:00-11:30 a.m. and 12:30-5:30 p.m. (EST). For support, call (800) 470-9630.
- What are the Payer/Receiver Codes for BlueChoice HealthPlan?
South Carolina Professional: 00403
South Carolina Institutional: 00403
- How many claims do we receive electronically?
Approximately 83 percent of claims are received electronically.
* Links on this page lead to third-party sites. Those companies are solely responsible for the
content and privacy policies on their site.