BCBSM Introduction
NOTE:
The numbers provided in this configuration guide are subject to change without notice. It is your responsibility to maintain the accuracy of these numbers in your system.
Electronic Document Interchange (EDI) is a way to exchange data using a standard format and communication protocol. ChiroTouch supports a subset of EDI standards for Health Care that is mandated by HIPAA. This standard is created and maintained by the ANSI X12 committee. The current version of ChiroTouch includes support for the 837 (claim) and 835 (remittance advice) EDI transactions. The process of exchanging the EDI documents is called “document trading” and the parties involved in that process are called “trading partners”.
Before you can start trading EDI documents with BCBSM, you must complete the following tasks:
- Enroll with BCBSM
- Configure ChiroTouch for EDI
- Test your configuration and sample data by creating and submitting a test file
These tasks are described in greater detail later on in this document.
Enrollment
To enroll with BCBSM EDI clearinghouse please contact their EDI Help Desk at:
URL: http://www.bcbsm.com/provider/electronic_data_interchange/self_submitter_software.shtml
Phone: 1-800-542-0945
You will need to complete their Trading Partner Agreement and receive a Submitter ID.
Important Note: You need to contact ChiroTouch support and register your Submitter ID under ChiroTouch vendor account for ANSI X12 837 claims.
BCBSM EDI documentation and manuals:
http://www.bcbsm.com/provider/electronic_data_interchange/documentation_professional_manuals.shtml
Configuration
EDI makes use of several data identifiers that define key entities included on the exchanged documents. These include site, doctors, patients, payers, and trading partners. Using identifiers instead of names greatly reduces data entry mistakes and removes naming discrepancies between different organizations. The following section describes all data elements that need to be configured for successful EDI. Please refer to the ChiroTouch Manual for more information on how to use the EDI configuration screens.
Trading Partner Configuration
BCBSM is considered an electronic document trading partner for your organization. A trading partner in ChiroTouch is defined by a few data elements that are specified on the Trading Partners screen.
The table below shows all data elements that need to be specified for BCBSM. It does not show any elements that can be left with their default values.
|
Partner Name and Identifier: |
|
|
Organization Name |
BCBSM |
|
Identifier Qualifier |
Mutually Defined [ZZ] |
|
Identifier Value |
382069753 |
|
ETIN |
00710 |
|
Application Code |
382069753 |
|
Site Name and Identifiers |
|
|
Organization Name |
Site name is used automatically and it cannot be changed here |
|
Identifier Qualifier |
Mutually Defined [ZZ] |
|
Identifier Value |
The Submitter ID assigned by BCBSM. This identifier is 5 characters in length starting with C. Example: C0XYZ. |
|
ETIN |
The Submitter ID assigned by BCBSM (same as above) |
|
Application Code |
The Submitter ID assigned by BCBSM (same as above) |
|
Transaction Options |
|
| Usage Indicator | Set to “Test” initially, before creating first test claims file. Set to “Production” after that. |
|
835 File Name Mask |
835* |
|
Registered Payers |
|
|
Primary Identifier |
Use Payer ID from the Commercial Payer List available at http://www.bcbsm.com/pdf/commercial_payer_list.pdf. Contact BCBSM EDI Help Desk for Payer IDs for Medicare and other non-commercial payers. |
|
Secondary ID Qualifier |
Claim Office Number [FY] |
|
Secondary Identifier |
Defined in the same Payer List. It could be blank. |
|
Claim Filing Indicator |
Selected the value that matches the payer type. It is important to use “Medicare B” for Medicare and “Blue Cross/Blue Shield” for BCBS. Other payers may use “Commercial Insurance” or whatever matches their type. |
|
Designated Partner |
BCBSM |
Site Configuration
Your site in many cases will be used as the EDI Billing Provider and Pay-To Provider for claims and remits. The table below shows all the data elements that need to be specified on the Site screen. It does not show any elements that can be left with their default values.
|
Billing Name and Address |
|
|
Name |
You site billing name (same as in ChiroTouchMaintenance) |
|
Address Line 1 |
You site billing address line 1 (same as in ChiroTouchMaintenance) Note: PO box is no longer accepted as a valid billing address |
|
Address Line 2 |
You site billing address line 2 (same as in ChiroTouchMaintenance) |
|
City, State, and Zip |
You site billing address city, state, and zip code |
|
NPI (type 2) |
A type 2 (organization) NPI assigned to your practice / site |
|
Employer Number / Tax ID |
A Tax ID assigned to your practice / site |
|
Taxonomy Code |
Leave this blank. BCBSM does not allow taxonomy codes on the site level. |
|
EDI Administrative Contact |
|
|
Name |
The name of the contact person in your office for EDI transmissions |
|
|
The e-mail of the contact person in your office for EDI transmissions |
|
Phone |
The phone of the contact person in your office for EDI transmissions Omit punctuation (ex: 2061231234) |
|
Fax |
The fax of the contact person in your office for EDI transmissions Omit punctuation (ex: 2061231234) |
Provider Configuration
Each provider that appears on the claim must be configured for EDI using the Providers screen. Other practitioners do not need to be configured. The table below shows common data elements that need to be specified for each provider. It does not show any elements that can be left with their default values.
|
EDI Rendering Provider |
|
|
Last Name |
Provider last name |
|
First Name |
Provider first name |
|
Middle Name |
Provider middle name (optional) |
|
Suffix |
Provider suffix |
|
NPI (type 1) |
A type 1 (personal) NPI assigned to the provider |
|
SSN |
Social Security Number of the provider |
|
Taxonomy Code |
A specialty code. Valid code values are: 111N00000X = Chiropractic 111N10900X = Internist 111NN0400X = Neurology 111NN1001X = Nutrition 111NX0100X = Occupational Medicine 111NX0800X = Orthopedic 111NR0200X = Radiology 111NS0005X = Sports Physician 111NT0100X = Thermography |
Upload and Download File Location Configuration
BCBSM exchanges files using secured file transfer protocol (SFTP). This protocol requires 3-rd party FTP software to be installed on the user’s computer. Installation and configuration of 3-rd party FTP software is outside of the scope of this guide. Please refer to BCBSM SFTP Instructions (http://www.bcbsm.com/pdf/SFTP_instructions.pdf) for more information.
When uploading claim files, pick them from the path specified below (replace “servername” with the actual server name):
\\yourservername\CTData\EDI\BCBSM\INBOUND
When downloading ERA and report files, place them in path specified below (replace “servername” with the actual server name):
\\yourservername\CTData\EDI\BCBSM\OUTBOUND
Please ask your IT professional if you don’t know your ChiroTouch server name.
Testing
There is no need to create and validate any test claim files with BCBSM as a site. ChiroTouch has already been tested withBCBSM and has been approved as a vendor.
5010 Readiness
You may switch the version of claims from 4010 to 5010 under the “Trading Partner” screen once you have confirmed that BCBSM is ready to accept them for all payers.
ChiroTouch has already been tested and approved to use 5010 claims.