Name of Manual - Blue Cross and Blue Shield of Minnesota

Electronic Commerce
Overview An important part of Blue Cross’ cost containment strategy is
automating the electronic exchange of information.
At Your Service
Electronic Transactions Blue Cross accepts the submission and/or generates the following
HIPAA compliant transactions:
Electronic Data
Interchange (EDI)
Guidelines
Health Care Claim (837 P and D)
Health Care Claim Payment/Advice (835)
Health Care Eligibility Benefit Inquiry and Response
(270/271)
Health Care Claim Status Request and Response (276/277)
Health Care Services Review- Request for Review and
Response (278)
Blue Cross uses Availity for exchanging HIPAA mandated EDI
transactions. You can get information on how to register and
conduct electronic transactions through Availity by going to
Availity.com.
Minnesota Statute 62J.536 requires all Minnesota providers
and Minnesota group purchasers to exchange three transactions
electronically: Health Care Claims, Health Care Claim
Payment/Advice and Health Care Eligibility Benefit Inquiry
and Response. In addition, participating out-of-state providers
are required by contract to adhere to these electronic
requirements.
All nonparticipating, out-of-state providers who do not have
electronic claim submission capabilities must submit their
claims on an optical character recognition scannable claim
form.
All nonparticipating, out-of-state providers who are receiving
direct payment must access their remittance advice via use of
the electronic transaction or provider web self-service.
Blue Cross reserves the right to modify these guidelines with
advance written notice.
Providers are encouraged to obtain or develop EDI transaction
software from the many sources available.
Blue Cross and Blue Shield of Minnesota Provider Policy and Procedure Manual (10/24/11) 1-19