• 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

    Find out more:

    • What insurance plans can I bill?
    • What types of claims can I bill electronically?  
    • How do I get started sending claims electronically?  
    • How do I bill Corrected/Replacement claims electronically? 
    • I have a question not covered in this section. Contact us  
  • Plans

    Premera accepts claims for the following:

    Alaska 

    • 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)

    Washington  

    • Premera Blue Cross
    • LifeWise Health Plan of Washington
    • LifeWise Health Plan of Oregon
    • BlueCard® (Out-of-area) Program
    • Federal Employee Program (FEP) where applicable*
    • NASCO (National Accounts)

    *Premera accepts professional FEP medical claims from all physicians and healthcare providers in Eastern Washington counties except Walla Walla, Yakima and Asotin. Please bill claims for care received in these counties to Regence Blue Shield. Premera accepts institutional FEP claims for all counties within the state of Washington.

    Claim Types Professional - Institutional

    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 .

    Getting Started

    Getting Started

    To 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.