Electronic Solutions

HIPAA Information

The Health Insurance Portability and Accountability Act (HIPAA) mandates the standardization of EDI formats for health care data transmission, which includes claims, remittance, eligibility and claim status inquiries. HIPAA regulations replace the CMS 1500 and UB04 Claims formats with ASC X12N 837 Transactions.

The BCBSNC Companion Guide is available to assist trading partners in understanding Blue Cross and Blue Shield of North Carolina (BCBSNC) code and situation handling used in processing the ANSI ASC X12N Transactions. In October, 2010, two different versions of the Companion Guide will be available: one for x12 version 4010 and one for x12 version 5010.

HIPAA 5010 Migration Information

BCBSNC plans to migrate its EDI stakeholders from the HIPAA X12 4010 to the HIPAA X12 5010 transactions during the course of 2011. Not all of the HIPAA 5010 transactions will be available for migration at the same time but once a trading partner has been migrated for the 837, 270/271, 276/277 or the 278 transaction, they may send either the HIPAA 4010 or the HIPAA 5010 version for the duration of 2011. See the HIPAA 5010 Migration Overview for more information about the HIPAA 5010 migration. Besides contact information, the document contains information about the process, timeline, and special rules for our EDI trading partners that will be enforced during the HIPAA 5010 Migration.