EDI

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Contact Information  
E-Solutions 
Phone: (800) 470-9630  
Hours: 8:00 - 4:30 MST M-F  
 
Welcome to Anthem Blue Cross and Blue Shield's E-Solutions page for the West Region – Colorado and Nevada.  
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 system via modem 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.  
 
Why submit claims electronically?
Electronic claims represent a savings of up to $2.00 per claim in the provider's office by reducing the amount of paperwork.
Electronic claims are not subject to postal delays
Claims may be transmitted 24 hours a day, seven days a week
Electronic claims are faster and more accurate than paper claims.
An electronic remittance advise is offered to all electronic submitters. This provides a cost savings and allows the provider to post payments automatically.
Electronic claims are acknowledged by Anthem Blue Cross and Blue Shield through notification accept/reject reports, which are placed in your mailbox the day after transmission
 
What are the Myth Busters about submitting my claims electronically?
Anthem DOES accept claims electronically that will require additional paperwork. 
Send us your claim electronically indicating that paperwork will be forthcoming (ask your vendor how to populate the PWK02 in Loop 2300 with BM). Then forward the paperwork by mail using the Attachment Face Sheet available on our website – www.edi.anthem.com. 
 
Anthem DOES accept adjusted or voided claims electronically.
Ask your software vendor how to do these 2 simple steps: 
populate the claim with a frequency type code of 7 (adjustment) or 8 (void)
populate the Original Reference Number ICN/DCN in Loop 2300 with the Anthem claim number
 
Anthem DOES accept COB claims electronically.
Claims with Anthem as secondary or even tertiary payer are accepted and pay more promptly when submitted electronically. See our Companion Documents for information on populating Loop 2320 – Other Subscriber Information for Coordination of Benefits. 
 
Anthem DOES accept electronic claims for out-of-state Blue Cross Blue Shield plans.
Anthem will accept and forward electronic claims for most of the Blue Cross Blue Shield plans. Simply include these claims within your transmission file and Anthem will route them according to the subscriber’s certificate ID. 
 
Anthem DOES accept all types of claims electronically, including home health claims.
The government mandates of the Health Insurance Portability and Accountability Act require Anthem to accept all claim types electronically. Contact us today for more information. 
 
Anthem DOES provide an immediate acknowledgement of your electronic claims file.
Electronic transactions produce an immediate acknowledgement report, a virtual receipt of your claims. You will also receive a response report listing claim detail and initial entry rejections, which can immediately be corrected and resubmitted. 
Anthem DOES have software solutions.
Anthem can provide a list of approved software vendors and clearinghouses.  
 
Which claims may be submitted electronically?
We accept all claims electronically, including all Institutional and Professional (Local BCBS, HMO, FEP, National and Bluecard) and we accept electronic attachments.  
 
How can I find out more about options for Electronic Data Interchance (EDI) with Anthem Blue Cross and Blue Shield- Colorado/Nevada? 
You may also call our EDI Team toll-free at (800) 332-7575 or email us at EDI.ENT.Support@anthem.com  
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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use