Blue Choice

Electronic Data Interchange (EDI)

The Health Insurance Portability and Accountability Act (HIPAA) is the federal regulation that requires the use of standard X12 transactions to report and inquire about health care services. If you use electronic transactions, you had to implement HIPAA 5010 by January 1, 2012. After January 1, 2012, version 4010A1 is no longer valid.

HIPAA 5010

    Registration

    Trading Partner Agreement
    Trading Partner Registration Form

    Electronic Remittance Advice (ERA) Application Form 

    Combined Electronic Remittance Advice (ERA)/Electronic Funds Transfer (EFT) or EFT only registration - Providers seeking to register or manage account changes for EFT only, or EFT and ERA combined, will need to use the Council for Affordable Quality Health Care (CAQH) Enrollment Tool, a secure electronic ERA/EFT registration platform. This tool will help eliminate the need for paper registration and reduce administrative time and costs and allow you to register with multiple payers at one time.

    Providers previously registered with us to receive combined ERA/EFT or EFT (only) will register with CAQH to manage account changes, but otherwise do not need to take action. Paper registration forms for combined ERA/EFT or EFT (only) are being discontinued and are no longer available.

    ERA (only) Registration Form - Providers or their third party billing agents (e.g. billing vendor or clearinghouse) will use this form to register and manage account changes for ERA only. The CAQH enrollment process must be used for providers seeking to enroll for EFT or ERA/EFT combined.

    Documents 

    Claims Processing Information
    4010A1 HIPAA Companion Guide

    Implementation Checklist 

    Contact Information

    The EDI Solutions Help Desk is available Mondays - Fridays from 8 a.m. to 4:30 p.m EST. 

    Phone: 800-470-9630

    Email: BlueChoiceSCEDI@wellpoint.com

    News and Bulletins  

    Find out more about Electronic Data Interchange.