Electronic Solutions

Agreements, Forms, and Instructions for download:

5010 Migration Request Form
Use this form to notify BCBSNC that you are ready to migrate from the HIPAA 4010A1 to the HIPAA 5010 version. This form is intended for use by clearinghouses, billing services, software vendors and providers who send directly to BCBSNC (and not through a clearinghouse or billing service).	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 Health Care provider wishing to transmit files electronically to BCBSNC needs to complete. See ECR: Information and Instructions for details.
ECR - 837, 27X, 835* (Supports 5010 versions only) *Note that the 835 Remittance Advice is offered only to participating providers.	download
Medicare Crossover 835 ECR Form	download
ECR: Information and 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 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