Providers
HIPAA standards
Access forms required by the Health Insurance Portability and Accountability Act (HIPAA), which mandates the standardization of Electronic Data Interchange (EDI) formats for health care data transmission, including claims, remittance, eligibility, and claim status inquiries.
HIPAA agreements, forms, and instructions
Trading Partner Agreement
The Trading Partner Agreement establishes the formal business relationship between a sender or receiver of electronic files and Blue Cross and Blue Shield of North Carolina.
New trading partners will receive this agreement electronically after the new trading partner has submitted the Electronic Connectivity Request (ECR) form to Blue Cross NC eSolutions and eSolutions has processed the request.
Complete one of the ECR forms and submit to eSolutions to begin the process.
New trading partners will receive this agreement electronically after the new trading partner has submitted the Electronic Connectivity Request (ECR) form to Blue Cross NC eSolutions and eSolutions has processed the request.
Complete one of the ECR forms and submit to eSolutions to begin the process.
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Understand how Blue Cross and Blue Shield of North Carolina (Blue Cross NC) processes ANSI ASC X12N transactions with our companion guides.
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Find the ERC form you need
Any entity wishing to exchange HIPAA (X12) files with Blue Cross NC must submit the appropriate ECR form. Select the appropriate forms based on your role as either a healthcare provider or a clearinghouse or billing service.
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For clearinghouses or billing services ECR form
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If you do not currently exchange HIPAA (X12) files with Blue Cross NC or you want to add a transaction type to the transactions you currently exchange, complete this ECR form and submit it online.
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Download Form (PDF)
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Download BCBSNC eSolutions Electronic Connectivity Request Form for Clearinghouses/Billing Services (PDF)
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card-1-b9d04d7f5c-050f9052b5-For clearinghouses or billing services Electronic Connectivity Request (ECR)
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For providers submitting directly ECR form
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If you do not currently exchange HIPAA (X12) files with Blue Cross NC or you want to add a transaction type to the transactions you currently exchange, complete this ECR form and submit it online.
Don't use this form to request an Electronic Remittance Advice (835 transaction).
Don't use this form to request an Electronic Remittance Advice (835 transaction).
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Download Form (PDF)
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Download BCBSNC eSolutions Electronic Connectivity Request Form for direct submitting providers (PDF)
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card-1-058f36a907-aa7050f5be-For providers submitting directly Electronic Connectivity Request (ECR)
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For healthcare providers requesting Electronic Remittance Advice (ERA) 835
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Use this form to request receipt of an ERA (835) if you need to submit the request via fax. You will need to print and fax this form to Blue Cross NC. See the 835 Enrollment Form Guidelines on the form for instructions.
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Download Form (PDF)
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Download BCBSNC electronic remittance advice authorization agreement (PDF)
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card-1-632f129f26-b5b46dfa93-For healthcare providers requesting Electronic Remittance Advice (ERA) 835
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Download Help Document for Completing 835 (PDF)
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Download BCBSNC 835 enrollment form guideline (PDF)
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Medicare Crossover 835 ECR form
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Use this form when giving Medicare services to members who have additional coverage with a different Blue Cross and Blue Shield (BCBS) plan.
Blue Cross NC electronically forwards 835 remittances for Medicare crossover claims received from other BCBS plans to providers with NPIs registered with Blue Cross NC to receive them.
You must also receive 835 Remittances (not associated with Medicare) to be able to submit this form.
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Download Form (PDF)
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Download BCBS interplan batch electronic connectivity request form (PDF)
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card-1-0aa1639ded-c9d7da19ee-Medicare Crossover 835 Electronic Connectivity Request (ECR) form
HIPAA testing
Trading partners who send electronic transmissions directly to Blue Cross NC must test for HIPAA compliance before they can transmit to Blue Cross NC production environment. Blue Cross NC offers free testing for its trading partners through a web-based application. 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 website prior to submitting files for testing. For detailed information about registering and submitting test files, download the Instructions for HIPAA testing with Blue Cross NC Community Portal (PDF).
HIPAA versions 5010 companion guides
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HIPAA sample documents
You can expect to receive the following electronic format transactions or reports as a result of your batch transmission:
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Claims audit report sample
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This sample document illustrates the Blue Cross NC proprietary Claims Audit Report. Providers can download the Claims Audit Reports from their Blue Cross NC electronic mailboxes or receive them from their clearinghouses. The Claims Audit Report is returned for 837 Health Care Claim transactions only.
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Download Sample (PDF)
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Download Claims audit report sample PDF
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card-1-2b171b64c5-497c9538aa-Claims audit report sample
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999 Functional Acknowledgment sample
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This sample provides illustrations of three different 999 Functional Group Acknowledgments. The 999 transaction serves as both a positive acknowledgment and a report of Implementation Guide errors within a Functional Group (GS / GE) or a Transaction Set (ST / SE).
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Download Sample (PDF)
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Download 999 Functional Acknowledgment Sample PDF
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card-1-a99769d56d-db89e60525-999 Functional Acknowledgment sample
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TA1 Interchange Acknowledgment sample
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This sample provides two illustrations of the TA1 Interchange Acknowledgment Transaction. The TA1 may provide a positive acknowledgment of the transmission or a negative acknowledgment that includes a report of Implementation Guide errors within an Interchange Control (ISA / IEA).
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Download Sample (PDF)
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Download TA1 Interchange Acknowledgment Sample PDF
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card-1-62aba9e532-f991b04e5e-TA1 Interchange Acknowledgment sample
Frequently asked questions
HIPAA information
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EDI requirements
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Trading partners, vendors, and clearinghouses
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