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Electronic Claim SubmissionElectronic Claim Submission

Electronic Claim Submission allows providers to safely submit and track HIPAA-compliant electronic claims to Florida Blue via Availity without manual intervention.

Electronic claims must be filed through Availity or send your claims through a billing service or clearinghouse to transmit to Availity and then route to Florida Blue. Availity edits transactions according to the HIPAA-AS requirements. A limited number of payer specific edits are also performed before routing transactions to Florida Blue.

If a claim transaction fails either the HIPAA-AS or Florida Blue edits, Availity will not forward the claim to Florida Blue for payment.

Availity will return an error message to the sender (sender is defined as the entity that submitted the claims to Availity; this may be a provider, billing service, or another clearinghouse) to correct and resubmit the claims electronically. If you use a billing service or another clearinghouse to submit your transactions to Availity, it is the billing service/clearinghouse’s responsibility to return the Availity file acknowledgements and EBRs to you.

Note: A clearinghouse, billing service or information management system may have electronic claim validation processes in place. Senders should contact their vendor with questions about these differences. Availity offers online real-time and batch EDI claim submission options. The responses returned to the sender are different.  

  • Claims can be entered on the Availity web screen and submitted to Florida Blue using Availity’s online real-time claim submission transaction. A real-time adjudication response or an acknowledgement indicating that the claim has been forwarded for further processing is returned to the sender. This response is received within minutes.
  • Claims can be created in a billing system and submitted to Florida Blue using Availity’s EDI batch submission functionality. A file acknowledgement that explains the file’s acceptance or rejection by Availity is usually returned within minutes. Availity will return an EBR, usually within minutes, that lists total number of claims submitted, total claims accepted by Florida Blue and detailed information on claims that failed the HIPAA or Florida Blue edits. Providers may also choose to receive detailed information on all accepted claims as well. Claims listed as failed should be corrected and resubmitted electronically in a new EDI batch file with a unique batch transaction ID.
Note: Allow 30-days for receiving payment from Medicare and the Blue Plan before you resubmit Medicare Supplement claims. Accurate and complete claims, which include National Provider Identifiers, cross over to our system after Medicare processes them. Medicare releases the claim to the Blue Plan secondary payer for processing when they send your Medicare remittance notice.  
Visit our website for electronic transmission support information.
Electronic Submission of Corrected Claims – Less paper and faster processing  
Providers with EDI or batch processing are able to electronically submit corrected claims to Florida Blue via Availity. If you file these claims with the appropriate bill or frequency type codes listed below, then they can be included in your normal electronic submission process (e.g., HIS, PMS). Contact your vendor if you need assistance identifying the loop and segment for the type codes.
Note: The feature is currently in development for providers who submit via Availity’s web-based system and will be available in the future.
For institutional claims, use the three-digit Bill Type (XX7 or XX8) ending in the appropriate number. 
For professional claims, use the appropriate number (7 or 8) for the Frequency Type.
7 – Replacement of Prior Claim
If you have omitted charges or changed claim information (diagnosis codes, dates of service, member information, etc.), resubmit the entire claim, including all previous information and any corrected or additional information.
8 – Void/Cancel of Prior Claim
If you have submitted a claim to BCBSF in error, resubmit the entire claim. If the claim was paid, resubmit the claim to Florida Blue using the Claim Overpayment Refund Form.


6/4/2013
The Manual is not intended to be a complete statement of all BCBSF polices or procedures for providers. Other policies and procedures, not included in this Manual, may be posted on our website or published in special publications, including but not limited to, letters, bulletins, or newsletters. Any section of this Manual may be updated at any time. In the event of any inconsistency between information contained in this Manual and the agreement(s) between you or your facility and BCBSF or Health Options the terms of such agreement(s) shall govern.

The Manual is not intended to be a complete statement of all Florida Blue polices or procedures for providers. Other policies and procedures, not included in this Manual, may be posted on our website or published in special publications, including but not limited to, letters, bulletins, or newsletters. Any section of this Manual may be updated at any time. In the event of any inconsistency between information contained in this Manual and the agreement(s) between you or your facility and Florida Blue or Health Options the terms of such agreement(s) shall govern.

Refer to the References section to view all applicable copyrights, registered trademarks, service marks, and/or references. Acronyms are also defined in the References section.

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