Electronic Data Interchange (EDI)
ELECTRONIC CLAIMS FILING TIPS
- Insured’s first and last name must be submitted as it appears on the BCBS member ID card.
- Patient’s first and last name must be submitted as it has been enrolled. Providers may verify spelling through the eligibility option located in the Providers Secure Section.
- The only special characters allowed in the name fields are a hypen (-) and a space. Claims will be rejected if they contain an apostrophe (‘).
Frequently Asked Questions
- Can I submit secondary BCBSKS claims electronically?
A. Both primary and secondary BCBSKS claims are accepted electronically. Check with your software vendor regarding the capabilities of your software.
NOTE: The only claims that must continue to be submitted on paper at this time are BCBSKS cross-over claims when Medicare is primary and the cross-over process did not occur.
- Can I submit all BCBSKS plans electronically?
A. All BCBSKS claims may be submitted electronically, regardless of the Plan (ie: Premier Blue, Blue Select, Blue Choice, etc) type.
- Can I submit BCBS claims from out-of-area plans?
A. Out-of-area BCBS claims may be sent electronically along with your BCBSKS claims. The 3-character alpha prefix from the member ID card is required when present, and must be included on the claim for proper routing.
- Can I receive electronic remits if I send claims through a clearinghouse?
A. Providers are encouraged to receive electronic remits whether sending directly or through a clearinghouse or billing service. Check with your billing service or clearinghouse for details on utilizing this transaction.
- How will I know if my BCBSKS claims made it to the processing system?
A. Response reports are available for download within 2 hours of receiving your file. The Confirmation Report lists out claims that are accepted and forwarded for processing, as well as those claims that rejected. An explanation of any rejected claims will be given on this report. Rejected claims must be corrected and resubmitted.