Electronic Data Interchange (EDI)
PW_035984
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Welcome to Anthem Blue Cross and Blue Shield’s E-Solutions page for Virginia.
Contact Information
E-Solutions
Phone: (800) 470-9630
Hours: 8:00 – 4:30 ET M-F
What is Electronic Data Interchange?
Electronic data interchange (EDI) allows providers to submit claims, retrieve remittance advices and retrieve claim file acknowledgements from their computer systems via modems and phone lines to the insurance carrier or clearinghouse.
How many claims do we receive electronically?
Approximately 93% of claims submitted to Anthem are received electronically.
Submitting Claims Electronically
Claims that can be submitted electronically to Anthem Blue Cross and Blue Shield.
Anthem accepts ALL institutional, professional and dental claims. This includes claims from PAR / PPO, HMO, the Federal Employee Program (FEP), national accounts and the BlueCard® Program (out-of-area).
Anthem DOES accept electronic claims with other insurance.
Anthem does accept electronic claims with Anthem as the secondary or even tertiary payer – with timely payments as a result. See the coordination of benefits (COB) section for information on completing fields when other insurance is involved. Refer to the appropriate chapter for claim type (professional, facility or dental 837 transactions) found in the Anthem companion guide.
Anthem DOES accept electronic claims for out-of-state Blue Cross and Blue Shield plans.
Anthem will accept and forward electronic claims for most of the Blue Cross and Blue Shield plans nationwide handled through the BlueCard® Program (out-of-area). Please include these claims within your transmission file, and Anthem will route them according to the members’ ID numbers and associated alpha prefixes.
Anthem DOES accept claims electronically that require additional paperwork.
We accept claims that require additional paperwork – just send Anthem your claim electronically, indicating that paperwork will be forthcoming. (Ask your vendor how to complete the PWK02 in Loop 2300 with BM or FX). Next, forward the paperwork by mail or facsimile, using Anthem’s 151 Claim Information/Adjustment Request. See our “EDI Publications” link under the “Communications” tab on the Virginia section of our Web site at www.anthem.com/edi for complete instructions. Anthem publishes communications and related information regarding the electronic data interchange (EDI) process on our Web site.
Anthem regularly communicates with our EDI vendors, providing information on system modifications and EDI-related issues. Visit the Virginia section of our Web site at www.anthem.com/edi. Select the “News Bulletins” link under the “Communications” tab to view our trading partner communications. In addition, select EDI Publications to view EDI troubleshooting tips, helpful hints for EDI submission and much more.
What are the Payer Codes for Virginia 1000B NM109 and 2010BB NM109?
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Virginia
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058916206CMSCOS
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058916206CMSCOS
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058916206CMSCOS
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What payer ID code do I use?
If you submit electronic claims/transactions directly to Anthem Blue Cross Blue Shield, please use the applicable code listed above. If you submit through a clearinghouse or use a software vendor, you should check with them for the correct value that should be used. Many clearing agencies use proprietary values therefore we do not assign or maintain payer ID codes for other entities, clearinghouses or vendors.
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