Access our secured site to check eligibility, claims, certifications, referrals and much more
LoginLogin
Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements

View requirements for Local Plan and BlueCard Out-of-Area members.

Search our online provider directory when you need a doctor, hospital, or other health care provider.

Electronic Data Interchange (EDI)

PW_AD031449

Customer Service Rating by LivePerson

Click for Live Assistance!

 

Welcome to Blue Cross and Blue Shield of Georgia’s E-Solutions page  
Contact Information  
E-Solutions 
Phone: (800) 470-9630  
Hours: 8:00 – 4:30 ET M-F  
 
Electronic Data Interchange (EDI) is the computer-to-computer transfer of business-to-business document transactions and information between trading partners. Many healthcare partners, payors, vendors and fiscal intermediaries choose EDI as a fast, inexpensive, and safe method for automating the business processes that take place. 
 
Are there standards for exchanging information in healthcare EDI?  
The constituencies involved in health care, including healthcare partner organizations, payors, benefit plan sponsors, financial institutions and others have jointly developed and approved specific transaction sets, or standards, for use in sending and receiving healthcare information and transactions electronically. These EDI transaction sets and their associated approved American National Standards Institute (ANSI) ASC X12 transaction set numbers are listed below. 

Transaction Name 
ASC X12 Transaction 
Reference 
Implementation Guide (IG) 
Washington Publishing Co. 
Health Claims and Equivalent Encounter Information 
837 
www.wpc-edi.com/hipaa 
Enrollment and Disenrollment in a Health Plan 
834 
www.wpc-edi.com/hipaa 
Eligibility Inquiry/Response for a Health Plan 
270/271 -real-time only 
www.wpc-edi.com/hipaa 
Healthcare Remittance Advice (ERA) 
835 
www.wpc-edi.com/hipaa 
Health Plan Premium Payments 
820 
www.wpc-edi.com/hipaa 
Health Claim Status 
276/277 -real-time only 
www.wpc-edi.com/hipaa 
Referral Certification and Authorization 
278 
www.wpc-edi.com/hipaa 
Coordination of Benefits 
837 
www.wpc-edi.com/hipaa 
Electronic Attachments  
275/HL7/LOINC 
www.wpc-edi.com/hipaa 
 
What are the benefits derived from using these standards?  
Keeping health care affordable to the end consumer.
Improving accuracy of information exchanged between healthcare participants, improving the quality of healthcare delivery and its supporting processes.
Making enhanced information available to all healthcare participants as appropriate. This access ensures fast, reliable, accurate, secure and detailed information on patients and healthcare partner plans.
 
EDI Services is committed to delivering the value that EDI brings to all healthcare participants. 
 
For more information: 
EDI Latest News

Alerts, reminders, important EDI announcements 

Web Claims Submission

Option for exchanging electronic transactions. 

EDI Communications

Vendor & Healthcare Partner Links and Publications

EDI Seminars

Schedule of Provider Outreach Seminars and Events

EDI Vendor Listing

Required for choosing approved clearinghouse organizations that have successfully tested electronic transactions via the GA Gateway. 

Free On-Line HIPAA Validation Testing

An on-line tool for direct EDI submitters to utilize for HIPAA transaction and code set testing. 

HIPAA Validator Testing Guidelines

Guidelines for using the HIPAA Validator. 

Learn More about EDI Standards and Benefits

ASC X12 is the U.S. standards body for the cross-industry development, maintenance, and publication of electronic data exchange standards, based on, but not limited to X12 EDI, XML, and UN/EDIFACT formats. Washington Publishing Company is an active member of ASC X12 and publishes the output of X12's subcommittees.

5010

Latest 5010 News 

Private Business - HIPAA Companion Guide

For non-Medicare Part A NEW and migrating trading partners using the Enterprise Gateway/Clearinghouse 

Combined Electronic Remittance Advice (ERA)/Electronic Funds Transfer (EFT) or EFT only registration

Providers seeking to register or manage account changes for EFT only, or EFT and ERA combined, will need to use the Council for Affordable Quality Health Care (CAQH) Enrollment Tool , a secure electronic ERA/EFT registration platform. This tool will help eliminate the need for paper registration and reduce administrative time and costs and allow you to register with multiple payers at one time. Paper is discontinued when Blue Cross and Blue Shield of Georgia EFT payments begin. Providers can sign up for Electronic Remittance Advice (ERA) or may be able to view images of the EOP on the provider portal.

Providers previously registered with us to receive combined ERA/EFT or EFT (only) will register with CAQH to manage account changes, but otherwise do not need to take action. Paper registration forms for combined ERA/EFT or EFT (only) are being discontinued and are no longer available.

Electronic Data Interchange (EDI) and ERA(only) Registration Form-

This form can be used to register for any supported EDI transaction. This form can be used by providers or their third party billing agents (e.g. billing vendor or clearinghouse) to register and manage account changes for ERA (only). The CAQH enrollment process must be used for providers seeking to enroll for EFT or ERA/EFT combined.

ERA Registration forms will be accepted for processing provided that the allowable fields defined in the CAQH CORE 382: ERA Enrollment Data Rule are included. Do not populate fields that are not required. We will disregard any additional information not included in the CORE maximum data elements required.

HIPAA

Latest HIPAA News

 
What are the Payer Codes for BCBSGA 1000B NM109 and 2010BB NM109? 

  Professional Institutional Dental
Georgia 
00601 
00101 
BCBSGA 
 
What payer ID code do I use? 
If you submit electronic claims/transactions directly to BlueCross BlueShield of Georgia, please use the applicable code listed above. If you submit through a clearinghouse or use a software vendor, you should check with them for the correct value that should be used. Many clearing agencies use proprietary values therefore we do not assign or maintain payer ID codes for other entities, clearinghouses or vendors.  
© 2014 BlueCross BlueShield of Georgia
Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.