- Business Transformation
- Policies & Guidelines
Claims and Billing
- X12 Gateway Transition
- National Provider Identifier (NPI)
- Electronic Data Interchange (EDI) Services
- Claims Requirements and Communications
- Claims Submission Addresses
- Claims Requiring Submission of Clinical Information
- Chiropractic Billing Guide
- Clear Claim Connection and Significant Edits Disclosure Report
- Tools and Resources
- Pharmacy Information
- Resources for Patient Management
- Contact Us
Electronic Data Interchange (EDI)
Simplifying electronic claims submissions
Submitting claims may be one of the most common, time-consuming, and complex administrative tasks that your office staff performs. Using an electronic method – EDI – can result in increased accuracy of claims, better tracking ability, and greater office efficiency and productivity.
In addition, you’ll also benefit from error reporting, which allows you to easily correct claims before submission. You will experience fewer payer rejections and administrative complications, resulting in faster claim payments.
Submitting Claims Through EDI
When your office submits claims electronically for Independence Blue Cross (IBC), you must use the National Association of Insurance Commissioners (NAIC) code 54704 in the EDI header record to direct your files to IBC.
Product codes are also assigned by NAIC for each of our product lines. A list of professional and facility payer ID codes are available in the following documents:
Note: Clearinghouses may update their submission rules from time to time. Always contact your clearinghouse for confirmation of up-to-date, specific submission requirements.
If you are interested in submitting electronic claims and have existing practice management software, please contact your vendor as they will more than likely have an existing clearinghouse vendor that connects to our gateway. Refer to the document below for a list of clearinghouse vendors that can connect directly to our gateway.
X12 Gateway Transition
At IBC, we’re 75 years strong and still changing the game – working hard to enhance the health and wellness of the people and communities we serve. This means offering the right technology, tools, and processes – which is why we decided to migrate our core processing activities to a new operating platform managed by Highmark Health Services (Highmark), an independent company.
Moving our processing capabilities to a new platform will enable us to offer greater capabilities, increased flexibility in benefit design, and enhanced functionalities to improve the experience for IBC trading partners. IBC employees will continue to process IBC claims but will be using Highmark’s systems instead of IBC systems.
A key early step in the migration to the new platform is the transition of EDI transactions from our current gateway to the Highmark Gateway. In the second quarter of 2013, we began this process.
To assist trading partners during this transition, we created the EDI Trading Partner Business Center, where they can register to submit and receive transactions through the Highmark Gateway. The Trading Partner Business Center also provides additional references and information about submitting transactions through the Highmark Gateway.
If you have received an email that contains your new DataStream Trading Partner ID for the Highmark Gateway, please click the registration link in that email to electronically accept your new Trading Partner Agreement (TPA) and register the receipt of your new DataStream Trading Partner ID.Trading partners who have not yet received their new DataStream Trading Partner ID:
If you have not yet received an email that contains your new DataStream Trading Partner ID, please contact us at firstname.lastname@example.org.New trading partners:
If you are a new trading partner who would like to register to submit IBC claims transactions, please visit the EDI Trading Partner Business Center. On this site you can register to submit and receive transactions through the Highmark Gateway, electronically accept a TPA, and receive your DataStream Trading Partner ID and new logon credentials.
IBC and Highmark are committed to ensuring a seamless transition with comprehensive communications and tools before, during, and after the transition to the Highmark Gateway and platform. For more information about the transition to the Highmark Gateway, please visit our X12 Gateway Transition page. If you have any further questions about the transition to the Highmark Gateway or your time frame for migrating to the Highmark Gateway, please email us at email@example.com.