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Electronic Solutions

Agreements, Forms, and Instructions for download:

Trading Partner Agreement
This contract establishes the formal relationship between a sender of electronic files and Blue Cross and Blue Shield of North Carolina. This agreement, along with the Electronic Connectivity Request Form, needs to be completed by all trading partners and mailed to EDI Services before electronic transmissions are exchanged. download
Trading Partner Agreement Instructions
These instructions include information about who needs to complete the form, to whom it is sent, and what other forms need to be included for a complete package. download
Electronic Connectivity Request (ECR) Forms
Any entity wishing to exchange HIPAA (X12) files with BCBSNC must submit the appropriate ECR form. Select the appropriate forms based on your role as either a healthcare provider or a clearinghouse/billing service.
See ECR: Information and Instructions for more details.
For Clearinghouses or Billing Services: If you do not currently exchange HIPAA (X12) files with BCBSNC or you want to add a transaction type to the transactions you currently exchange, complete this ECR form and submit it online. download
For Healthcare Providers: If you do not currently exchange HIPAA (X12) files with BCBSNC or you want to add a transaction type to the transactions you currently exchange, complete this ECR form and submit it online. However, do NOT use this form to request an Electronic Remittance Advice (835 transaction). download
For Healthcare Providers requesting ERA (835): Use this form to request receipt of an Electronic Remittance Advice (835). See the 835 Enrollment Form Guidelines below for instructions. This form can be completed and submitted online. download
For Healthcare Providers requesting ERA (835): Use this form to request receipt of an Electronic Remittance Advice (835) if you need to submit the request via fax. This form must be printed and faxed to BCBSNC. See the 835 Enrollment Form Guidelines below for instructions. download
Medicare Crossover 835 ECR Form download
ECR: Information and Instructions
835/ERA-specific instructions to complete an 835 Enrollment Form. Use these instructions if you are a Healthcare Provider. download
Electronic Funds Transfer (EFT) Authorization Form
Complete an Electronic Funds Transfer (EFT) Authorization Form to have claims payments deposited directly to your bank account. Direct deposit payments are generally faster and safer than paper checks. Instructions for completing and submitting the form are included. download

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