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 HCFA 1500 and UB92 Claims formats with ASC X12N 837 Transactions. EDI Services has produced a Companion Guide 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.

HIPAA regulation has mandated the use of a National Provider Identifier (NPI) for all health care providers by May 23, 2007. BCBSNC requires all healthcare providers to obtain, register, and use an NPI by the Federally mandated compliance date. For more information, see our NPI Pages.

HIPAA Testing

Trading Partners who send electronic transmissions directly to BCBSNC must test for HIPAA compliance before they can transmit to BCBSNC production environment. BCBSNC offers free testing for its trading partners through a Web-based application. The application is available at the BCBSNC Community Portal Web site. This testing tool provides analysis of test files, specific information on errors, and enables users to keep a history of files tested. The site can also be used to run production files for senders who would like to verify the compliance of their files prior to transmission.

Trading partners must register at the Web site prior to submitting files for testing. For detailed information about registering and submitting test files, download the Instructions for HIPAA testing with BCBSNC Community Portal.

Companion Guide for download

Receive Update Notification by E-mail

BCBSNC strives to ensure that the documents and forms on our site are kept up-to-date. We want to be sure you always have the latest version of all necessary documents.

If you would like to be notified by e-mail when the Companion Guide is updated, please fill out our registration form. Registration is not required to download the Companion Guide.

Companion Guide Chapters (pdf)/HIPAA Transaction	Chapter Version
Introduction to the Companion Guide for EDI Transactions (for all Trading Partners)	Version 5.5
837 Institutional Health Care Claim	Version 4.9
837 Professional Health Care Claim	Version 6.6
835 Health Care Claim Payment/Advice (for participating providers only)	Version 5.5
270 and 271 Health Care Eligibility Inquiry and Response	Version 6.2
276 and 277 Claim Status Request and Response	Version 6
278 Health Care Services Review and Response	Version 2
BCBSNC HIPAA Glossary	Version 1
Appendix A: Adjustment Reason Codes	Version 2.2
Appendix B: BCBSNC Business Edits for 837 Professional	Version 6.5
Appendix C: BCBSNC Business Edits for 837 Institutional	Version 5.4
HCFA Mapping to LPF and 837	Version 1
UB92 Mapping to LPF and 837	Version 2

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 Health Care provider wishing to transmit files electronically to BCBSNC needs to complete. See ECR: Information and Instructions for details.
ECR - 837, 27X, 835* *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

HIPAA Sample Documents

You can expect to receive the following electronic format transactions or reports as a result of your batch transmission:

Claims Audit Report Sample
This sample document illustrates the BCBSNC proprietary Claims Audit Report. Providers can download the Claims Audit Reports from their BCBSNC electronic mailboxes or receive them from their clearinghouses. The Claims Audit Report is returned for 837 Health Care Claim transactions only.	download NEW
997 Functional Acknowledgement Sample
This sample provides illustrations of three different 997 Functional Group Acknowledgements. The 997 transaction serves as both a positive acknowledgement and a report of Implementation Guide errors within a Functional Group (GS/GE) or a Transaction Set (ST/SE).	download
TA1 Acknowledgement Sample
This sample provides two illustrations of the TA1 Interchange Acknowledgement Transaction. The TA1 may provide a positive acknowledgement of the transmission or a negative acknowledgement that includes a report of Implementation Guide errors within an Interchange Control (ISA/IEA).	download
Help
FAQ	download

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