Electronic Solutions

HIPAA Information | HIPAA Testing | Companion Guide | HIPAA Sample Documents

Agreements, Forms, and Instructions for download:

Trading Partner Agreement

The Trading Partner Agreement establishes the formal business relationship between a sender/receiver of electronic files and Blue Cross and Blue Shield of North Carolina. This agreement will be sent electronically to new trading partners during the set up period by the EDI Analyst. To start the process, complete the appropriate Electronic Connectivity Request form and submit it to eSolutions.

Electronic Connectivity Request (ECR) Forms

Any entity wishing to exchange HIPAA (X12) files with Blue Cross NC must submit the appropriate ECR form. Select the appropriate forms based on your role as either a healthcare provider or a clearinghouse/billing service.

See ECR: Information and Instructions for more details.

For Clearinghouses or Billing Services:

If you do not currently exchange HIPAA (X12) files with Blue Cross NC or you want to add a transaction type to the transactions you currently exchange, complete this ECR form and submit it online.

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For Healthcare Providers:

If you do not currently exchange HIPAA (X12) files with Blue Cross NC or you want to add a transaction type to the transactions you currently exchange, complete this ECR form and submit it online. However, do NOT use this form to request an Electronic Remittance Advice (835 transaction).

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For Healthcare Providers requesting ERA (835):

Use this form to request receipt of an Electronic Remittance Advice (835) if you need to submit the request via fax. This form must be printed and faxed to Blue Cross NC. See the 835 Enrollment Form Guidelines below for instructions.

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Medicare Crossover 835 ECR Form

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ECR: Information and Instructions

835/ERA-specific instructions:

Use these instructions if you are a Healthcare Provider to complete an 835 Enrollment Form.

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Electronic Funds Transfer (EFT) Authorization Form

Complete an Electronic Funds Transfer (EFT) Authorization Form to have claims payments deposited directly to your bank account. Direct deposit payments are generally faster and safer than paper checks. Instructions for completing and submitting the form are included.

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