Premera Blue Cross (PBC) accepts electronic claims either by direct submission or from selected clearinghouses. Sending electronic claims offers several advantages:
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:
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 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.
The following claim types may be billed electronically:
Currently, PBC uses ANSI 837 Healthcare Claim ASC X12N Version 4010A1 for the claim types below:
Note: ANSI 837 Healthcare Claim ASC X12N Version 5010 will be mandated for use on June 30, 2012.
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:
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:
Providers should submit a corrected or replacement claim electronically using the HIPAA 837 standard claims transaction, and include the following information:
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
Telephone: 800-435-2715 option 1
Telephone: 800-435-2715 option 2
Telephone: 800-435-2715 option 3
Premera Blue CrossP.O. Box 327Mail Stop 481, EDISeattle, WA 98111-0327
Premera Blue CrossMail Stop 4817001 220th Street SWMountlake Terrace, WA 98043-2124