• What is ICD-10? How does it affect you and how can you prepare for it?Electronic Claims: Overview

    Premera Blue Cross (PBC) accepts electronic claims either by direct submission or from selected clearinghouses. Sending electronic claims offers several advantages:

    • Less time spent on claims preparation
    • Cost savings through prevention of loss and potential delay
    • Detailed claim acceptance and rejection reporting
    • Faster claims processing and response times
    • A professional staff available to assist you with EDI (Electronic Data Interchange) matters
  • Start Submitting Claims Electronically

    1. Contact your software vendor directly to discuss installing electronic media claims capabilities in your office. If you need a list of approved software vendors, contact us.
    2. After you select your software, contact our EDI (Electronic Data Interchange) department to obtain electronic submitter agreements and enrollment information.
    3. Next, send your test files. If you use an approved Clearinghouse, no testing is required.
    4. After approval for production, send claim files and monitor your reports.

    Secure Transport (ST)

    Sending electronic claims is accomplished via Secure Transport and by logging into our web site: www.connectiva.com. Secure Transport is a product of the Tumbleweed Communications Corp that allows the transfer of files through a secure Internet connection. It utilizes the standard security protocol of HTTPS and integrates SSL and Digital Certificate (X.509). It is a field-proven, complete solution that allows for the reliable delivery of both large and small files.

    Your access to connectiva.com will be through a One Health Port (OHP) User ID number, which you may already have. Please register for an OHP User ID at www.onehealthport.com.

    Premera Secure Transport services include:

    • The ability to upload claims files
    • Convenience – www.connectiva.com web site is available 24 hours a day, 7 days a week
    • File upload success confirmation or error notification
    • The ability to send and receive HIPAA standard transactions
    • Online access to download:
      • All Premera electronic reports
      • Electronic Remittance Advice (ANSI 835) for Premera products

    ST is available 24 hours a day, 7 days a week.
    For questions regarding your Secure Transport connection, contact our EDI Team at 800-435-2715.

    Premera accepts claims for the following:

    • Premera Blue Cross Blue Shield of Alaska
    • LifeWise Health Plan of Washington
    • LifeWise Health Plan of Oregon
    • BlueCard (Out-of-area) Program
    • Federal Employee Program (FEP)
    • NASCO (National Accounts)

    Claim Types

    The following claim types may be billed electronically:

    Professional

    • Medical
    • Vision
    • Dental
    • Durable Medical Equipment
    • Chiropractic
    • Other Alternative Healthcare Services

    Institutional

    • Institutional and Facility claims
    • FEP institutional claims for all counties within the states of Washington and Alaska

    Dental

    • PBC accepts dental claims from providers nationwide (exception: Washington FEP)
    • FEP Dental Claims 
      • Premera accepts Federal Employee Program (FEP) dental claims for Alaska only
      • Premera does not accept Washington FEP dental claims, these must be submitted to Regence Blue Shield
      • Premera Blue Cross Dental Payer ID is 47570

    Electronic Format

    Currently, PBC uses ANSI 837 Healthcare Claim ASC X12N Version 4010A1 for the claim types below:

    • Professional Claims
    • Dental Claims
    • Institutional Claims

    Note: ANSI 837 Healthcare Claim ASC X12N Version 5010 will be mandated for use on June 30, 2012.

    More information 

    Reports

    Electronic Claims Reporting

    The EDI (Electronic Data Interchange) process will return a 997 (Functional Acknowledgement transaction) and Electronic Claims Transaction Reports to the submitting entity. For more information about 997s see HIPAA/EDI FAQ.

    Electronic Reporting provides the following:

    • Specific detail on claims that have failed our HIPAA validation.
    • List of claims that are rejected upfront and will not reach our adjudication system
    • Detailed information on all claims that were accepted for adjudication and any claims that were rejected for member eligibility.

    Note: Reports are posted electronically at www.connectiva.com.

    A corrected/replacement claim is any claim that has changes or corrections to one of the following:

    • Diagnosis code
    • Date of service/date span
    • Total charges or units billed
    • Member/patient or provider
    • Originally submitted procedure code
    • Modifier on a previously processed claim
    • Charges for services not previously billed (late charges)

    Instructions for Submitting Corrected/Replacement Claims

    Providers should submit a corrected or replacement claim electronically using the HIPAA 837 standard claims transaction, and include the following information:

    • Frequency Code of ‘7’ in Loop 2300, CLM05-3 segment to indicate a corrected/replacement of a prior claim
    • All services from the original claim, including the corrected services
    • The initial Premera claim reference number or claim number (in Loop 2300, REF01 must contain “F8” and REF02 must contain the claim number)
    • A free-form note with an explanation for the Corrected/Replacement Claim, in Loop 2300 ‘Claim Note’, as:

      For Professional & Dental Claims, segment NTE01 must contain ‘ADD’ and segment NTE02 must contain the note, Example: NTE*ADD*CORRECTED PROCEDURE CODE

      For Institutional Claims, segment NTE01 must contain ‘UPI’ and segment NTE02 must contain the note, Example: NTE*UPI*CORRECTED LAB CHARGES

    More Information and Resources

    Contact Us

    Mountlake Terrace, WA

    (Seattle Office)
    Telephone: 800-435-2715 option 1
    Fax: 425-918-4234

    Spokane, WA

    Telephone: 800-435-2715 option 2
    Fax: 509-532-6352
    EDI@premera.com 

    Bend, OR

    Telephone: 800-435-2715 option 3
    Fax: 541-318-2337
    EDI@premera.com 

    Mailing Address

    Premera Blue Cross
    P.O. Box 327
    Mail Stop 481, EDI
    Seattle, WA 98111-0327

    Delivery Address:

    Premera Blue Cross
    Mail Stop 481
    7001 220th Street SW
    Mountlake Terrace, WA 98043-2124