It's easy to exchange electronic transactions through an approved Electronic Data Interchange (EDI) clearinghouse or with Blue Shield of California directly through secure file transfer protocol.

Real-time eligibility & benefit and claim status inquiries are also available over secure http/s protocols. If you are interested in real-time inquiries, please contact your practice management system vendor or clearinghouse. Reference the Blue Shield EDI Clearinghouse list (PDF, 82 KB) to see if your vendor or clearinghouse is already directly connected with Blue Shield. If you would like direct connectivity, please download the EDI Companion Guide for Blue Shield-specific requirements and details on how to enroll.

Read below to find out when to use a clearinghouse and when to connect directly with Blue Shield of California. Then follow the steps to enroll.

Using an EDI Clearinghouse

If your office submits less than 1,500 claims per month with Blue Shield of California, using an approved EDI clearinghouse is probably best for you. Blue Shield of California Promise Health Plan claims must be submitted electronically using Office Ally or Change Healthcare clearinghouse.

Blue Shield’s approved EDI clearinghouses typically offer a variety of services that can help reduce your administrative costs by increasing your office efficiency.

To exchange electronic transactions with Blue Shield through Office Ally and other clearinghouses, you must have an internet connection.

Steps to enroll with a clearinghouse

To exchange electronic transactions with Blue Shield using an EDI clearinghouse, follow these simple instructions:

Step 1

For Blue Shield of California providers:

Choose a Blue Shield Approved EDI Clearinghouse from our list.

Download the List of Approved Clearinghouses (PDF, 89 KB)

For Blue Shield of California Promise Health Plan providers:

To receive electronic remittance advices (ERAs) for Blue Shield Promise claims, register with an approved clearinghouse. Download the list of approved clearinghouses (PDF, 89 KB).

To send Blue Shield Promise claims electronically, use only the approved clearinghouse listed below:

OfficeAlly
Payer ID: C1SCA
(866) 575-4120
www.officeally.com

Step 2

Enrollment in ERA and EFT online
Blue Shield of CA provides a way to electronically indicate a contracted provider’s vendor preference for ERA, as well as to enroll in electronic funds transfer (EFT). Certified, contracted providers should do the following:

  1. Log in to their Provider Connection account
  2. Go to Account Management
  3. Go to the Provider & Practitioner Profiles section
  4. Once in the provider demographics dashboard, if there’s more than one provider organization, select the right TIN and then click “Search” to refresh the page.
  5. Next, locate the Remittance & Payments tab and submit vendor preference. In that same tab, you can also enroll the TIN organization in EFT.

Step 3

Contact the selected EDI clearinghouse to enroll and begin exchanging electronic transactions.

Next steps

Blue Shield will send confirmation of your enrollment in electronic payments within 30 business days. Electronic Remittance Advice are available in one business day and funds are deposited within two business days after your claims finalize.

 

Connecting directly with Blue Shield of California

Organizations that submit more than 1,500 claims per month to Blue Shield of California may choose secure file transfer protocol (SFTP) using a direct connection with Blue Shield.

Eliminating your vendor for one or more types of EDI transactions may allow you to reduce or avoid monthly fees or transfer delays and provides next-day access to Blue Shield’s detailed EDI validation reports.

Organizations that choose direct SFTP typically have a dedicated IT staff to update and maintain their EDI software. These organizations are responsible for ensuring their own compliance with HIPAA dataset and transaction regulations, and for compatibility with payer edits.

Steps to enroll for a direct connection to Blue Shield

To establish a direct SFTP connection or enable exchange of additional types of EDI transactions with Blue Shield of California, follow these simple instructions:

Step 1

If you do not currently have a Trading Partner Agreement with Blue Shield of California, you must complete and return the Trading Partner Agreement to the address or fax number listed below.

Download the Trading Partner Agreement form (PDF, 59 KB)

Step 2

Complete and return all parts of the Trading Partner Enrollment Packet to the address or fax number listed below.

Download the Trading Partner Enrollment Packet (PDF, 130 KB)

Current Trading Partners requesting updates to their EDI enrollment information should use the following forms to request updates. Please allow two weeks’ advance notice of any changes in your information to avoid interruptions to your service.

  • To request updates to the list of Tax IDs or NPIs to be included in your submissions, download the Tax Identification Number Detail form (PDF, 41 KB).
  • To request updates to banking information for Direct Deposit, or to have a client authorize release of electronic remittance advice (835) to a Third Party (clearinghouse), download the ePayments Provider Authorization form (PDF, 173 KB).
  • To request updates to your IP Address information, download and complete both parts of the SFTP Connectivity Detail form (PDF, 105 KB).

Next steps

Please allow up to six weeks to establish a new direct connection with Blue Shield of California.

Blue Shield will send confirmation of your enrollment in electronic payments within 30 business days. You will automatically begin receiving EDI claims confirmation and standard reports. Learn more about our EDI Claim Confirmation Report (PDF, 740 KB).

Electronic Remittance Advice are available in one business day and funds are deposited within two business days after your claims finalize.

Trading partners who exchange electronic transactions directly with Blue Shield should consult our EDI Companion Guides for any Blue Shield-specific requirements.

Visit our HIPAA 5010 and ICD-10 Implementation page for scheduling and testing information.