Physicians/Specialists
Facilities/Hospitals
Ancillary
Pharmacy
Publication Date: 
2021-02-15

Please note: This communication applies to Healthy Blue + MedicareSM (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC).

Electronic data interchange
Blue Cross NC uses Availity as its exclusive partner for managing all electronic data interchange (EDI) transactions. EDI, including electronic remittance advices (ERA) and electronic funds transfers (EFT), allows for a faster, more efficient and cost-effective way for providers and employers to do business.

Advantages of EDI:

  • Process claims faster by submitting coordination of benefits electronically and fixing errors early with in-system notification and correction.
  • Reduce overhead and administrative costs by eliminating paper claim submissions.
  • Speed up enrollment and payment for employer groups benefits.
  • Upload files through File Transfer Protocol (FTP) or directly in Availity as a batch or single claim submission.

As a Healthy Blue + Medicare provider, you can complete the following HIPAA transactions in Availity:

  • Healthcare Claim: Professional (837P)
  • Healthcare Claim: Institutional (837I)
  • Healthcare Claim: Dental (837D)
  • Healthcare Eligibility Benefit Inquiry and Response (270/271)
  • Healthcare Services Prior Authorization (278)
  • Healthcare Services Inpatient Admission and Discharge Notification (278N)
  • Healthcare Claim Payment/Advice (835)
  • Healthcare Claim Status Request and Response (276/277)
  • Medical Attachments (275)

Ways you can use EDI with Availity

  • Availity’s EDI submission options:
    • EDI Clearinghouse for direct submitters
  • Or use your existing clearinghouse vendor:
    • Work with your vendor to ensure connection to the Availity EDI Gateway

Payer ID
Payer IDs route EDI transactions to the appropriate payer.

Healthy Blue + Medicare payer ID:
North Carolina — 00602

Note: If you use a clearinghouse, billing service or vendor, please work with them directly to determine payer ID. These may be different when submitting Healthy Blue + Medicare EDIs in Availity.

Electronic remittance advice (835)
Use Availity to register and manage ERA account changes with these three easy steps:

  1. Log in to Availity.
  2. Select My Providers.
  3. Click on Enrollment Center and select Transaction Enrollment.

Note: If you use a clearinghouse, billing service or vendor, please work with them on ERA registration.

Electronic funds transfer (EFT)
Use the EnrollHub™, a CAQH Solutions™ enrollment tool to register and manage EFT account changes.

EnrollHub™ makes it easy for you to handle multiple payers at once, reducing administrative time and costs.

EDI trading partner
The trading partner, such as clearinghouse, billing company and vendor, connects with Availity’s EDI Gateway to send and receive EDI transmissions easily.

Already registered with Availity and want to submit EDI transactions?

  1. Log in to Availity.
  2. Click My Providers.
  3. Select Enrollments Center and then select Transaction Enrollment.
  4. Follow the steps to enroll as a trading partner.

New to Availity and want to submit EDI transactions?

  1. Choose an administrator to register your organization.
  2. When the administrator is ready to register, choose the register button on the top of the page.
  3. Select your organization type and complete the registration process.
  4. Administrator should check email to verify account.
  5. Once account has been verified, administrator will agree to the disclaimer, set up your security questions, and change password.

Contact Availity
Please contact Availity Client Services with any questions at 1-800-AVAILITY (282-4548).

 

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