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EDI

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.

Access Availity

Find important self-service tools to review ongoing claims, or check the eligibility of members under your care.

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 After Jan. 1, 2012, version 4010A1 is no longer valid.

HIPAA 5010

5010 Companion Guide

What's Changed for 5010

Companion Guide for 5010

Section A - EDI User Guide

Section B - Transaction Specific Companion Documents

EDI Registration

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.*

EFT Registration

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.

ERA Registration

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.*

Documents 

Contact Information

The EDI Solutions Help Desk is available Mondays - Fridays from 8 a.m. to 4:30 p.m. EST. 

Phone: 1-800-470-9630

Email: E-Solutions.support@wellpoint.com

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.

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