The fastest way to conduct business with BCBSTX throughout the entire claims process is via Electronic Data Interchange (EDI). EDI transactions are often identified by numbers assigned by the American National Standards Institute (ANSI). Here are some examples:
- Eligibility & benefits inquiry/response (ANSI 270/271)
- Referrals, pre-certification and authorizations (ANSI 278)
- Electronic claim submission (also known as Electronic Media Claims, or EMC) [ANSI 837P (Professional) or ANSI 837I (Institutional)]
- Claim status request/response (ANSI 276/277)
- Claim payment via Electronic Funds Transfer (ANSI 835 EFT)
- Electronic Remittance Advice (ANSI 835 ERA), or delivery of claims payment information
Online Transaction Schedule
Online Eligibility and Benefits (270/271) and Claims Status (276/277) transactions may be conducted almost continuously, except for Sunday, 8 p.m. to midnight, (CST)*.
* Non-routine downtime will be communicated via designated third party independent vendor websites at least one week in advance.
With Availity, health care providers can conduct transactions at no charge. It’s a comprehensive claims clearinghouse solution supporting numerous payers. Learn more about Availity.
Availity Essentials Pro is a fee for service that goes beyond conventional claims clearinghouses and uses smart technology and an intuitive interface to help you receive payments faster while reducing the administrative burden on your staff..
With EDI, health care providers can save time, money and delays in claims processing. View, track, and monitor claim status reports electronically…and more. Learn more about EDI Transactions.
EFT and ERA allow providers to securely and promptly receive funds and details regarding claims payment and remittance. Learn more about EFT and ERA.
This online refund management tool will help simplify overpayment reconciliation and related processes. The eRM application is available at no additional charge. Learn more about eRM.
We are committed to providing support to health care providers. Whether doing research or streamlining billing, these tools can help you evaluate costs, save time, improve service and more. Learn more about provider tools.