Provider automation provides avenues for electronic claims submission and we support ANSI HIPAA compliant version 5010 transactions.
Capital Blue Cross supports all ANSI HIPAA compliant version 5010 transactions, including:
Please set up a trading partner relationship prior to sending electronic data interchange (EDI) transactions. This defines a legal relationship and requirements for the exchange of EDI transactions. Contact our support center or provider automation to get started.
Allow until the next normal business day for for reported problems.
Scheduled outages occur on Sunday at 3:50 AM – 4:50 AM and 8:00 PM – 12:00 AM. Provider
automation will notify providers and trading partners via email. We’re closed on the following holidays. Allow until the next business day for technical help.
If your management system processes 835 transactions, you may be able to use our weekly electronic remittance information regarding claim decisions and payment. Complete the enrollment form below.
Electronic versions provide the same information as mailed statements. Access these documents with the secure file transfer (SFT) application on Availity Provider Portal or request direct secure file transfer protocol connection.
Methods of electronic submission:
Participating providers can submit HIPAA compliant files directly to us. Complete the Trading Partner Agreement and test the file for HIPAA and our requirements for transmission.
us or call at 800.874.8433, option 4.
Direct Data Entry
Submit CMS 1500 claims securely to Capital Blue Cross. Printable confirmation is displayed after submitting. A report identifying acceptance or rejection of the claim is available the next business day.
Register with Availity Provider Portal, a partner of Capital Blue Cross, to use the DDE claims entry option. Email us or call 800.874.8433 and ask for Provider Automation to see if our DDE service would meet your needs.
Utilize a clearinghouse if our direct methods do not suit your needs. We receive EDI claims and ANSI ASC X 12N current HIPAA compliant versions through clearinghouses.
Real Time Eligibility and Benefit and Claim Status Inquiries
We accept ANSI HIPAA compliant version 5010 270 eligibility inquiry real time request. We also accept ANSI HIPAA compliant version 5010 276 claims status inquiry real time requests. These requests include a single inquiry or submission (one eligibility inquiry to one information source for one patient). The response from Capital Blue Cross as the message receiver is either an error response or the corresponding X12 message response (TA1, 999 or 271).
Trading partners should send no more than one transaction per 2 seconds with 5 concurrent transactions.
Submit transactions directly to Capital Blue Cross, through a clearinghouse or vendor arrangement.
Real time processing is available a majority of the calendar week. Our maximum response time between trading partners of 4 seconds or less per hop with a total round trip of 20 seconds or less.