Self-Service Tools

Electronic self-service tools for providers are available through the Availity and BCBSF website. The tools and forms available on these sites can help providers reduce administrative costs, improve office workflows, and assist in the collection of claim payments. Checking Availity each time will ensure you receive the most recent member information.

Providers should always utilize self-service tools prior to contacting BCBSF. BCBSF has created a new fast path priority service process, using an Availity transaction ID (fast path code), to encourage providers to use Availity before calling the Provider Contact Center for benefit information. If you need to call the Provider Contact Center and do not use an Availity transaction ID (fast path code), you will experience longer wait times.   

Electronic Capability and Participation 

• Providers and/or their designees (billing services, clearing houses, etc.) are required to use clinical, financial and administrative electronic self-service capabilities including those accessed through Availity. These capabilities include but are not limited to: 
• Submitting administrative inquiries electronically through Availity using Authorizations and Referrals Review and Inquiry, Eligibility and Benefits, CareCalc, Claim Reconciliation Tool and Claims Status.
• Utilizing certain Availity transactions (Authorizations and Referrals Review and Inquiry, Eligibility and Benefits Inquiry). Providers should use the automated transaction and obtain an Availity transaction ID by accessing Availity. This transaction ID will provide fast path priority service if you should need to call BCBSF for assistance. Providers will not receive eligibility and benefits information from BCBSF without a transaction ID.
• Using paperless payment process [Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA)] and other electronic financial settlement tools such as claim reconciliation tool.
• Using clinical electronic tools such as CareProfile and electronic prescribing.
• Submitting claims electronically in the HIPAA 5010 format or subsequent versions mandated by the federal government.
• Submitting medical records electronically, when available.
• A condition of a providers continued participation with BCBSF is full utilization of the electronic capabilities set forth above.
• Providers ordering labs or other diagnostic tests for BCBSF members agree to allow BCBSF to share the results with the member’s other treating physicians. 
• If providers utilizes electronic technologies that meet the criteria of CMS “meaningful use", they will make every effort to use the same technology with BCBSF and on behalf of our members.
• At BCBSF’s request providers will direct their vendor(s) to work with BCBSF on their behalf to integrate this electronic technology into their system(s). 

Responsibilities of Participating Providers

Adhere to guidelines for usage of all electronic self-service tools. 

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Health Plan Transactions

HIPAA-AS compliant transactions available online in real-time and by electronic data interchange in batch include:

• ASC X12N 270/271 Health Care Eligibility Benefit Inquiry and Response
• ASC X12N 276/277 Health Care Claim Status Request and Response
• ASC X12N 278 Health Care Services Review – Request for Review and Response
• ASC X12N 835 Health Care Payment/Advice
• ASC X12N 837 Professional Health Care Claim/Institutional Health Care Claim

You may submit electronic transactions directly through Availity or through a billing service, which will then use Availity to submit claims to BCBSF. However, you must be Availity-connected to conduct eligibility and benefits inquiries, Health Care Services Review and Inquiries (authorizations and referrals), claim submissions and remittances. These services are offered at no charge to providers.

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Government Connections

Availity supports real-time Eligibility and Benefits, batch claims, and online Claim Correction for Medicare and Medicaid transactions in Florida. Florida Medicaid transactions are available at no cost. Medicare services are optional and are available at a nominal fee to providers.

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Other Blue Plans

Availity supports certain other Blue Plans electronic transaction capabilities such as Eligibility and Benefits, Claim Status, and Health Care Services Review. The electronic inquiry transaction on existing referral authorizations for other Blue Plan members is not available at this time. Hours of operation for other Blue Plans will vary. Time zone differences also affect availability, although some Blue Plans may have extended hours of availability.

Note: Information returned for eligibility and benefit inquiries, Health Care Services Review (referral authorization requests) and select claim status inquiries depend on information from other Blue Plans. Blue Plans that operate in real-time typically respond in less than one minute. If a Blue Plan operates in batch or if their system is unavailable, you will need to retrieve information using the Delayed Response function. This option is located within the Eligibility and Benefits, Auths and Referrals and Claims Management menus. Health Care Services Inquiries (on existing authorizations) are not available for other Blue Plans.

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BCBSF Hours of Availability for Electronic Transactions

Hours of operation for eligibility and benefits, claims submission, and Health Care Services Review and Inquiries are:

• Monday through Saturday 12 a.m. – 11 p.m. Eastern Time
• Sunday 12 a.m. – 5 p.m. Eastern Time

Hours of operation for claim status inquiries are:

• Monday through Saturday 24 hours a day
• Sunday 12 a.m. – 5 p.m. Eastern Time

Occasional system maintenance may affect hours of availability. If the system is unavailable, the Availity website will display an announcement.

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