It's easy to exchange electronic transactions through an approvedElectronic Data Interchange (EDI) clearinghouseor with Blue Shield of California directly throughsecure file transfer protocol.
Real-time eligibility and benefit and claim status inquiries are also available over secure http/s protocols. If you are interested in real-time inquiries, please contact your practice management system vendor or clearinghouse. Reference theBlueShieldEDIClearinghouselist(PDF, 82 KB) to see if your vendor or clearinghouse is already directly connected with Blue Shield. If you would like direct connectivity, please download theEDI Companion Guidefor Blue Shield-specific requirements and details on how to enroll.
Read below to find out when to use a clearinghouse and when to connect directly with Blue Shield of California. Then follow the steps to enroll.
Using an EDI clearinghouse
If your office submits less than 1,500 claims per month with Blue Shield of California, using an approved EDI clearinghouse is probably best for you.
Blue Shield’s approved EDI clearinghouses typically offer a variety of services that can help reduce your administrative costs by increasing your office efficiency.
To exchange electronic transactions with Blue Shield through Office Ally and other clearinghouses, you must have an internet connection.
Steps to enroll with a clearinghouse
To exchange electronic transactions with Blue Shield using an EDI clearinghouse, follow these simple instructions:
Step 1
For Blue Shield of California providers:
Choose a Blue Shield Approved EDI clearinghouse from our list.
Downloadthelistof approved clearinghouses(PDF, 89KB)
For Blue Shield of California Promise Health Plan providers:
To receive electronic remittance advices (ERAs) for Blue Shield Promise claims,register with an approved clearinghouse.Download the list of approvedclearinghouses(PDF, 89 KB).
To send Blue Shield Promise claims electronically, use only the approved clearinghouse listed below:
OfficeAlly
Payer ID: C1SCA
(866) 575-4120
www.officeally.com
Step 2
Enrollment in ERA and EFT online
Blue Shield of CA provides a way to electronically indicate a contracted provider’s vendor preference for ERA, as well as to enroll in electronic funds transfer (EFT). Certified, contracted providers should do the following:
- Log in to their Provider Connection account
- Go to Account Management
- Go to the Provider and Practitioner Profiles section
- Once in the provider demographics dashboard, if there’s more than one provider organization, select the right TIN and then click “Search” to refresh the page.
- Next, locate the Remittance & Payments tab and submit vendor preference. In that same tab, you can also enroll the TIN organization in EFT.
Step 3
Contact the selected EDI clearinghouse to enroll and begin exchanging electronic transactions.
Next steps
Blue Shield will send confirmation of your enrollment in electronic payments within 30 business days. Electronic Remittance Advice are available in one business day and funds are deposited within two business days after your claims finalize.
Connecting directly with Blue Shield of California
Organizations that submit more than 1,500 claims per month to Blue Shield of California may choose secure file transfer protocol (SFTP) using a direct connection with Blue Shield.
Eliminating your vendor for one or more types of EDI transactions may allow you to reduce or avoid monthly fees or transfer delays and provides next-day access to Blue Shield’s detailed EDI validation reports.
Organizations that choose direct SFTP typically have a dedicated IT staff to update and maintain their EDI software. These organizations are responsible for ensuring their own compliance with HIPAA dataset and transaction regulations, and for compatibility with payer edits.
Steps to enroll for a direct connection to Blue Shield
To establish a direct SFTP connection or enable exchange of additional types of EDI transactions with Blue Shield of California, follow these simple instructions:
Step 1
If you do not currently have a Trading Partner Agreement with Blue Shield of California, you must complete and return the Trading Partner Agreement to the address or fax number listed below.
Download the Trading Partner Agreement form(PDF, 59 KB)
Step 2
Complete and return all parts of the Trading Partner enrollment packet to the address or fax number listed below.
Download the Trading Partner enrollment packet(PDF, 130 KB)
Current Trading Partnersrequesting updates to their EDI enrollment information should use the following forms to request updates. Please allow two weeks’ advance notice of any changes in your information to avoid interruptions to your service.
- To request updates to thelist of Tax IDs or NPIsto be included in your submissions, download theTax Identification Number detail form(PDF, 41 KB).
- To request updates tobanking information for direct deposit, or to have a clientauthorize release of electronic remittance advice (835) to a third party(clearinghouse), download theePaymentsProvider authorizationform(PDF, 173KB).
- To request updates to yourIP addressinformation, download and complete both parts of theSFTP connectivity detail form(PDF, 105 KB).
Next steps
Please allow up to six weeks to establish a new direct connection with Blue Shield of California.
Blue Shield will send confirmation of your enrollment in electronic payments within 30 business days. You will automatically begin receiving EDI claims confirmation and standard reports. Learn more about ourEDI claim confirmation report(PDF, 740 KB).
Electronic Remittance Advice are available in one business day and funds are deposited within two business days after your claims finalize.
Trading partners who exchange electronic transactions directly with Blue Shield shouldconsult our EDI Companion Guidesfor any Blue Shield-specific requirements.
Visit our HIPAA 5010 and ICD-10 implementation pagefor scheduling and testing information.