Electronic Data Interchange (EDI)

EDI is a way for you to send and receive information about your claims as well as eligibility and benefits information about your patients electronically versus by paper or telephone. It is a more timely and efficient way to perform the daily business functions of health care.

The submission and retrieval of information electronically can save you time and money by decreasing paper and postage costs and eliminating the need to call Customer Service. When the information you need is available at your fingertips, more flexibility in how and when tasks are performed is possible.

The following information is available for electronic access:

• Contract eligibility
• Patient benefits
• Summary plan descriptions
• Claim status
• Fee schedule information
• Payment history
• Remittances
• Audit reports about claim submissions
• Referrals
• Precertifications

Please note that participation in the submission of electronic claims is required before access to the above information is authorized.

• Getting started
• Options for accessing electronic data with Blue Cross
• List of questions you may want to ask prospective vendors
• Check the Institutional Vendor Functionality Matrix
• Check the Physician Vendor Functionality Matrix
• Check the Dental Vendor Functionality Matrix
• Check the PCEMC+ vendor list
• Check the validated vendor contact list
• Audit Report Explanations