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Providers
  • Communications
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EDI Forms & Guides Archive

Below is an archive of 4010 guides and samples. Please note IBC currently conducts EDI business using the HIPAA 5010 standards. 4010 transaction submissions are no longer in compliance.

Claims Preprocessing Edits Claims Resolution

4010

  • Claims Preprocessing Edits Claims Resolution Document (10/2012)

HIPAA Transaction Companion Guides*

4010

  • Remittance Advice (835)
  • Claim - Institutional (837-I)
  • Claim - Professional (837-P)
  • Incoming Transaction Envelope
  • Outgoing Transaction Envelope

Trading Partner Specification

4010

  • U277 Trading Partner Specification (Claim Status Notification)

Sample Transactions (file formats & data elements)

4010

  • Remittance (835)
  • Claim - Institutional (837)
  • Claim - Professional (837)
  • Claim Acknowledgement (997)
  • Unsolicited Claim Status (U277)

For more information or assistance, please contact the EDI team or call the EDI Business Help Desk at 215-241-2305.

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Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.