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Electronic Data Interchange (EDI)

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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 

EDI Communications

Vendor & Healthcare Partner Links and Publications

EDI Seminars

Schedule of Provider Outreach Seminars and Events

Free On-Line HIPAA Validation Testing

BCBSGa offers its direct EDI submitters an on-line tool called Validator to utilize for HIPAA transaction and code set testing. Contact your local E-Solutions to obtain your User ID and password, and click on link for Validator Testing Guidelines. Note: Validator is also available to software vendors that service BCBSGa EDI submitters.

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.

HIPAA

Latest HIPAA News

5010

Latest 5010 News 

Private Business - HIPAA Companion Guide

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

EDI Registration Form

This form can be used to register for any supported EDI transaction.

Important Notification  
Blue Cross Blue Shield of Georgia has moved into a strategic partnership with Availity to serve as our designated EDI Gateway for all electronic data and transactions.  
Blue Cross Blue Shield of Georgia and Availity are committed to transparency with this change, and will emphasize the continuity of quality service to our trading partners.  
 
ERA registration  
As of June 1st 2018, please use Availity (www.availity.com) to manage account changes or new registrations for electronic remittance advices (835). Please check your organization to ensure you do not have an existing account.  
For any questions please contact Availity Client Services at 1-800-AVAILITY (282-4548)  
Manage suppression (turn off) paper remittance vouchers here.  
 
EFT registration  
To register or manage account changes for electronic funds transfers (EFT) only, use the EnrollHub™, a CAQH Solution™ enrollment tool, 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 change.  
 
Effective immediately, providers, billing services and clearinghouses that wish to become a direct connection can register to exchange EDI transactions at www.availity.com.  
Tip: Make sure you don’t have an existing account with Availity. 
Please go to www.availity.com , select Register and have the following available: 

Federal tax ID and NPI

The name of someone with the legal authority to sign agreements for your organization. Typically, this is an owner or senior partner.

The name of the administrator in your office who will need to grant and maintain access for your organization.

 
Who do I contact if I need help registering for Availity? 
For registration assistance, call Availity Client Services at 1-800-AVAILITY (282-4548) Monday through Friday from 8 a.m. to 7:30 p.m. Eastern time (excluding holidays).  
After you complete your registration, Availity will send you emails that include your next steps and temporary password. You may then begin adding other users for your organization.  
 
Are you already registered for Availity and you do not have an existing EDI account?  
Contact Availity Client Services at 1-800-AVAILITY (282-4548). Assistance is available Monday through Friday from 8 a.m. to 7:30 p.m. Eastern time (excluding holidays)  

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

State Professional Institutional Dental
Georgia 
00601 
00101 
BCBSGA 
 
What payer ID code do I use?
If you submit electronic claims/transactions directly to Blue Cross Blue Shield 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. 
 
© 2018 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.