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Reminder: Real-time Claim Status Available in November

Release Date: October 17, 2012

Please note:  This article has been revised from the original communication – the implementation date has changed from October 2012 to November 2012.  The original article announcing Real-time Claim Status can be accessed by visiting the Important News webpage at www.bcbsnc.com/providers.

Blue Cross and Blue Shield of North Carolina (BCBSNC) will be offering real-time claim status connectivity this November for all trading partners that are CAQH CORE certified.

The Department of Health and Human Services (HHS), as part of the Affordable Care Act, has adopted the CAQH CORE Phase I & II Operating Rules for Health Care Eligibility/Benefit (270/271) and Claim Status (276/277) Inquiries and Responses. The mandated implementation date of January 1, 2013 is rapidly approaching.

Effective in November 2012, BCBSNC will offer two new connectivity protocols, SOAP + WSDL and HTTP + MIME, in order to comply with these rules. We will continue to support our existing HTTP, FTP, and real-time SOAP protocols as well as these two new options. Real-time and batch file formats will be available for both the Health Eligibility and Claim Status transactions.

To enroll and use real-time Claim Status or real-time Eligibility processing, a new Electronic Connectivity Request (ECR) form needs to be submitted. You can find the new ECR form at the following link: http://www.bcbsnc.com/content/providers/edi/hipaainfo/agreements.htm

Becoming CAQH CORE certified and/or utilizing the real-time capabilities promotes the following:

  • Enhance interoperability between providers and payers
  • Streamline eligibility, benefits, and claim status transactions
  • Reduce the amount of time providers spend on administrative functions

For more information on CAQH CORE Operating Rules, please visit the CAQH website.  Details regarding connectivity, Health Care Eligibility, and Claim Status transactions are available in our Companion Guides located within the BCBSNC HIPAA 5010 Companion Guides.

For more information on these BCBSNC’s real-time offerings, contact the eSolutions Help Desk at EDICUSSUP@bcbsnc.com with “CAQH Question” as the subject line.