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EDI Enrollment

Our web-based EDI (Electronic Data Interchange) application will give you the ability to review the results of your EDI file processing online, the same day the file is transmitted. You will be able to:

  • view file processing statistics and transaction results, including benefits, enrollment adds, changes, and terminations;
  • correct errors online and resubmit transactions for processing;
  • release files for production processing;
  • create customized reports.

Independence Blue Cross (IBC) supports ANSI 834, METS, and HR-XML file formats for submitting EDI enrollment information on employer groups with 500 or more commercial contacts. Compare the features of each to gain insight into which format may be right for your business.

After you review the electronic options, please contact your IBC marketing representative to initiate an EDI discussion with our eBusiness Team.

Download our Guide to Your Electronic Options.

ANSI 834

Features of ANSI 834

  • Transactions are batched and sent as full or transactional files.
  • Confirmation responses are sent same day.
  • Easily transfer your ASC X12N 834 enrollment information from another health insurer to BC.
  • Extensive testing ensures successful implementation, which is generally accomplished in 2 – 4 months. (See the EDI Testing section later in the EDI Enrollment Link)
  • Compliant with HIPAA (Health Insurance Portability and Accountability Act of 1996) specifications for electronic exchange.

The following links provide information about the IBC ANSI 834 implementation.

ANSI X12 834 Companion Guide (Transactional Files)

ANSI X12 834 Companion Guide Addendum (Full Files)

For more detailed information on ANSI 834, refer to www.wpc-edi.com/hipaa/hipaa-40.asp.

METS

METS is short for Membership Electronic Transfer System. METS is a proprietary system developed by IBC for transferring enrollment and eligibility content from our clients through electronic transfers and feeds.

Features of METS

  • Implementation specifications and procedures provided by IBC.
  • Offers flexibility to tailor customer transaction processing and reporting according to specific needs.
  • Quick deployment time — typically 1 – 3 months. (See the EDI Testing section later in the EDI Enrollment Link)

The following link provides more detailed information about the METS implementation:

METS Implementation Guide

The implementation documents listed below will be provided for each electronic file format:

Group Number/Coverage Code Matrix — Sample

Implementation Plan/Timeline — Sample

HR-XML

HR-XML stands for Human Resource – Extensible Markup Language. This open data exchange standard was developed by the HR-XML consortium to enable the automation of human resource-related transactions. Using HR-XML, any company can transact with another without having to establish, engineer, and implement an interchange mechanism to do so.

Features of HR-XML

  • Real-time transmissions: as a transaction is entered into your human resource system, it is sent within seconds to IBC.
  • Transactions are confirmed immediately.
  • Easily transfer your HR-XML content from another health insurer to IBC.
  • Extensive testing ensures successful implementation, which is generally accomplished in 3 – 6 months. (See the EDI Testing section later in the Employer Reference EDI Link).

Our Companion Guide supporting the HR-XML Benefit Enrollment v2.5 Schema is now available.

HR-XML Implementation Guide v2.5

For more information on HR-XML in general, visit hr-xml.org.

EDI Testing

During implementation for any EDI file format, your IBC deployment team will work with you to create a comprehensive test plan to ensure the success of your electronic communications with us. Testing will include all applicable compliance and format testing. In addition, we will run a number of transactions to simulate a true production environment before your first live file is ever transmitted. The more scenarios we test, the greater the likelihood of quality and accuracy.

The following scenarios represent a sampling of test cases. Some may not be applicable to your plan design.

  • Add Single Contract
  • Add Husband & Wife Contract
  • Add Parent & Child Contract
  • Add Parent & Children Contract
  • Add Family Contract
  • Add Drug Product
  • Add Dental Product
  • Add Vision Product
  • Add Spouse Dependent
  • Add Child Dependent
  • Add Newborn Child Dependent
  • Add Overage Student Dependent
  • Change Subscriber’s Last Name, Address, and Phone Number
  • Change Electronic Identification Numbers — Same Product
  • Change Electronic Identification Numbers — Different Product
  • Add Additional Product Line of Business (Subscriber only) — Ancillary Products (Drug, Dental, Vision)
  • Add Additional Product Line of Business (All Dependents) — Ancillary Products (Drug, Dental, Vision)
  • Term Single Contract
  • Term Husband and Wife Contract
  • Term Family Contract
  • Term Non-HMO Contract — No ancillary products
  • Term Non-HMO Contract — With ancillary products
  • Term HMO Contract and NON-HMO ancillary product — (2 different electronic identification numbers)
  • Term Ancillary Product only
  • Term Multiple Products
  • Term Spouse
  • Term Child
  • Term Children
  • Term Spouse and Child(ren)
  • Term Overage Student

Making the Right Decision

When it comes to making the right decision for your company’s communications needs, choice is a good place to start. And IBC is here to help you take it from there. We can help analyze and explain your options to key players in your organization. We’ll make sure your benefit information is kept secure and transmitted with accuracy — whether you submit to us daily, weekly, or on your timetable. You’ll feel confident about Choosing Blue every step of the way.

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