Electronic Claim Submission
Electronic Claim Submission allows providers to safely submit and track HIPAA-compliant electronic claims to BCBSF 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 BCBSF. Availity edits transactions according to the HIPAA-AS requirements. A limited number of payer specific edits are also performed before routing transactions to BCBSF.
If a claim transaction fails either the HIPAA-AS or BCBSF edits, Availity will not forward the claim to BCBSF 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 BCBSF 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 BCBSF 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 BCBSF and detailed information on claims that failed the HIPAA or BCBSF 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.
Electronic Submission of Corrected Claims – Less paper and faster processing
Providers with EDI or batch processing are able to electronically submit corrected claims to BCBSF 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 BCBSF using the Claim Overpayment Refund Form