provider connection
 

Enroll in Electronic Data Interchange

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

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.

Existing trading partners: To add direct deposit to your account, or to enroll only in direct deposit, complete and return our ePayments Provider Authorization Form or enroll online.

 

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

An example is Office Ally, which offers free practice management software, and free set-up and training for your office staff. Office Ally’s PracticeMate software allows you to submit claims electronically, receive and automatically post electronic insurance payments, schedule patient appointments and more, at no cost to you.

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: Choose a Blue Shield Approved EDI Clearinghouse from our list.

Step 2:  Complete and return the ePayments Provider Authorization form to authorize Blue Shield to send electronic remittance advice (ERA) to a third party on your behalf, and designate a business account for direct deposit of your claim payments. You may also use this form to notify Blue Shield of a change in your clearinghouse or bank information.

Return Completed Form To:

By fax:
Attention: eBusiness Data Exchange
(530) 351-6150

By mail:
eBusiness Data Exchange
4700 Bechelli Lane
Redding, CA 96002

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

Contact the EDI Helpdesk at edi_bsc@blueshieldca.com or 800-480-1221 if you have questions or need help completing your forms.

 

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 middle-ware 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.

Step 2: Complete and return all parts of the the Trading Partner Enrollment Packet to the address or fax number listed below.

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.

Return Completed Forms To:

By fax:
Attention: eBusiness Data Exchange
(530) 351-6150

By mail:
eBusiness Data Exchange
4700 Bechelli Lane
Redding, CA 96002

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 10 business days. You will automatically begin receiving EDI claims confirmation and standard reports. Learn more about our EDI Claim Confirmation Report (PDF, 740KB).

Electronic Remittance Advice are available 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.

Contact the EDI Helpdesk at edi_bsc@blueshieldca.com or 800-480-1221 if you have questions or need help completing your forms.