Electronic Data Interchange (EDI)

Electronic data interchange (EDI) is the preferred method of submitting claims. Get started using the resources below.

If you are submitting claims through an approved clearinghouse/vendor, there is no EDI enrollment required and you will not need to submit the standard agreement and/or registration forms. As long as you have successfully completed the Credentialing Process, you can submit claims through any clearinghouse you prefer. For more information on the credentialing process, please visit Credentialing.

If you elect to submit claims directly rather than through a clearinghouse, please follow these steps:

One of the Trading Partner Agreements will be signed by a representative of BCBSNE and returned to you. An EDI Account Executive will then contact you regarding the certification and testing process for your electronic transactions. Once you are certified as a Trading Partner and transaction testing is complete, you will be approved to send files for processing.

Once you are enrolled in electronic health care claims, your EDI account executive will provide a copy of the free PC-ACE software if needed. This will allow you to submit electronic claims and manage submissions.

Find tips and guidance for uploading claims, sending secondary claims and adjusting or replacing claims.

ABILITY | PC-ACE Setup Instructions
Uploading Professional Claims
Sending Secondary Claims


Software Updates

PC-ACE is updated quarterly for CMS mandates, new code sets, and BCBSNE-specific changes.

Download PC-ACE Software Update Version 4.2 (updated April 2019)

Guide to installing PC-ACE updates
PC-ACE PRO 32 Claims Processing System User Manual (April 2019)

 

Find out the changes made to the software in the latest April 2019 update:

Claims Adjustments or Replacement

Note: PC-ACE is compatible with PCs. We don't offer support or access to our version of PC-Ace to providers who will not be using it to submit claims directly to BCBSNE.

File transfer allows you to send standard electronic transactions, transfer edit reports, and other files from BCBSNE back to your system. Available protocols for electronic transmission are SFTP and HTTPs. You can also submit through a secure location at https://seccomm.bcbsne.com.

For assistance, refer to the user guide:
Secure Web Transport User Guide

Reports and response transactions are provided to trading partners to enable them to track the transactions that are submitted. Each report reflects that different level of review has been completed. First, the transaction file is reviewed and finally in the case of 837 transactions, individual healthcare claims are reviewed. Only the claims that pass all reviews are submitted for processing. Rejects can occur at various points during the review process so all reports must be reviewed by the trading partner to determine status of the submission. The only way a trading partner is informed that a rejection has occurred is through one of these reports.

Transmission Reports
These reports reflect the progress of a transaction before it is submitted to BCBSNE for processing.

TA1 Report - Interchange Acknowledgment
The TA1 Report is generated as the result of a review of the data that was transmitted in the ISA segment of the transaction. A report is automatically generated if there is a problem with the transaction and the file will not be processed any further. If the ISA14 segment is a "1," this report is generated whether there is an error or not. This report is placed in the trading partner's mailbox within an hour of the transmission if there is an error or if the appropriate flag is set in the file.

999 Report - Functional Acknowledgment
The 999 is a standard X12 transaction. This process validates that the X12 file meets syntax and structure rules of the ANSI X12 Standard. This report is placed in the trading partner's mailbox within an hour of the transmission.

Claims Confirmation Report
This report is specific to claims processing and is not generated for any other type of healthcare transaction. The Claims Confirmation Report gives the trading partner a detailed view of each claim received in a specific file. The Claims Confirmation Report lists errors in syntax and structure compliance with HIPAA Implementation Guides for the 837's and any errors against BCBSNE business rules which are contained in our 837 Companion Document. This report is placed in the trading partner's mailbox within an hour of the transmission.

Chiropractor "Expanded" Report (SC)
The Chiropractor "Expanded" Report is the result of editing Nebraska Blue Shield chiropractic claims against a "patterns of treatment" database. The report is placed in the trading partner's mailbox the day after the 837 claim transaction is received.

Professional Claims (837P) (CMS) Also Dental (837D)

  • Individual NPI numbers or Type One MUST always be present to successfully process professional claims. Please populate the individual NPI's in the rendering provider loop of the electronic file (Loop 2310B - NM1 09).
  • If you also have a Group NPI or Type Two, you may populate that number in the Billing provider loop (Loop 2010AA - NM1 09). The individual NPI still needs to be present. (Loop 2310B - NM1 09)
  • If you only have an Individual NPI you can repeat the provider information in the Rendering loop (2310B) into the Billing provider loop (2010AA) or just create a Billing provider loop containing the Individual Type One provider NPI. The Individual or Type One NPI Must appear on all professional claims.

The Tax ID is still required.

Institutional Claims (837I) (UB04)

  • Type Two NPI numbers MUST be present to successfully process institutional claims. Please populate the Type Two (Group) NPI in the Billing provider Loop (2010AA - NM1 09).
  • Please be sure to use the NPI number that is appropriate for the service(s) on the claim. For example, do not use an acute care NPI on claims billed for your Skilled Nursing Facility, please use the NPI you assigned to your Skilled Nursing Facility.

The Tax ID is still required.

Standard Response Transactions
In addition to the 999 Functional Acknowledgment described previously, the HIPAA standard response reports supported include the 835 Health Care Claim Payment/Advice, 271 Health Care Eligibility/Benefit Inquiry and Information Response and 277 Health Care Claim Status Response. The 835 response is placed in the trading partner's mailbox the day after the claims are adjudicated by BCBSNE. The 271 and 277 responses are placed in the trading partner's mailbox the day after the transaction is received.

EDI Support

For questions regarding your electronic health care transaction, call 888-233-8351, option 3 or email edisupport@nebraskablue.com.