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BlueExchange Implementation

PW_040188
Access Eligibility, Claims Status, and Health Care Service Review Capabilities for BlueCard and FEP Members 
Coinciding with the October 16, 2003 implementation of the Transactions and Code Sets Rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Anthem is participating in a new program across all Blue Cross and Blue Shield (BCBS) plans called BlueExchange. 
BlueExchange allows Anthem providers to access patient information electronically, regardless of which BCBS plan houses the membership information.  
Providers will be able to submit eligibility, claim status, and health care service review requests for any Blue Cross and Blue Shield or FEP member, through the existing electronic provider self service tools provided by Anthem - including Electronic Data Interchange (EDI) and Anthem’s web based provider self service tools (refer to chart). Each of these transactions must be conducted in a standard HIPAA compliant format. 

Transaction

Electronic Data Interchange
(Batch)

Anthem Online Provider Services
(Web based provider self service)

Eligibility Inquiry and Response (270/271)

Available

Available

Claim Status Inquiry and Response (276/277)

Available

Available for Anthem East members

Referral Request/Authorization Request (278)

Available

Not Currently Available

 
Anthem providers who are interested in these services are advised to contact their Provider Relations representative to find out more about the exact options available in their service area. 
For Frequently Asked Questions about BlueExchange, click here
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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