What is EDI?
Electronic Data Interchange (EDI) allows providers to submit and receive electronic transactions from
their computer systems. EDI is available for most common health care business transactions, such as
claims processing, electronic remittance advices, claims status, eligibility inquiries, and automated
claims payments.
Contacting an EDI Specialist
For more information about electronic claims
filing, electronic remittance advice, eligibility
benefit inquiry, claim status and other
transactions, call an Anthem EDI specialist for
details. Our specialists can address questions
regarding registration, testing and the
implementation process. Providers can visit
our website and view the Anthem Companion
Guide for specific instructions on filing
transactions electronically. The site is also
the link to EDI registration, announcements
and electronic submission information.
Get connected
with Electronic Data
Interchange (EDI)
Advantages of Submitting Claims Electronically
Reduces inefficiencies associated with paper
claims processing and speeds claims processing.
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Accelerates payments.
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Front-end editing results in cleaner claims.
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Reduces administrative costs when compared to
paper claims.
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Live Chat Session
Produces daily reports, providing an audit trail
and claim status.
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Live Chat is an instant messaging service
where EDI Solutions specialists are available to
answer questions from our customers.
Getting Connected
Providers have two options for electronic filing
or submission:
Direct Submission
Providers can use their internal programming
staff or purchase vendor software to enhance
their existing systems to meet the Health
Insurance Portability and Accountability
Act (HIPAA) and Anthem data format and
quality standards.
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A copy of the EDI Companion Guide is
available at anthem.com/edi (select state)
and may be downloaded to assist with direct
connection set-up.
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Once the testing process is completed
with Anthem, providers can begin
electronic claim submissions without
a charge from Anthem.
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Clearinghouse/EDI Vendor Approach
Providers contract with an EDI vendor or
clearinghouse who may charge a fee for data
formatting and routing services.
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For more information,
visit our website at
anthem.com/edi.
The clearinghouse will edit, format and transmit
electronic transactions to the appropriate
insurance company.
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Anthem works directly with clearinghouses
and EDI vendors to ensure that our formatting
and quality standards have been satisfied.
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A current list of approved clearinghouses
is available at anthem.com/edi (select state).
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In Connecticut: Anthem Blue Cross and Blue Shield is the trade name for Anthem Health Plans, Inc. In Maine: Anthem
Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Maine, Inc. In New Hampshire: Anthem Blue
Cross and Blue Shield is the trade name of Anthem Health Plans of New Hampshire, Inc. Independent licensees of
the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark. The Blue Cross and Blue Shield
names and symbols are registered marks of the Blue Cross and Blue Shield Association.
PLNBR0756A Rev. 10/10
Five Easy Steps to Electronic Connectivity
Select a submission approach.
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Install/test submission approach.
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Register/test with EDI Solutions.
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Train office staff.
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Begin electronic submissions to Anthem.
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Electronic Remittance Advice (ERA)
Take Advantage of Automated
Remittance Posting
Anthem offers electronic delivery of remittance
advices. The remittance advice provides
information for the payee regarding claims
in their final status.
The content on the remittance advice meets
HIPAA requirements, containing nationally
recognized HIPAA-compliant remark codes used
by Medicare and other payers like Anthem.
Benefits of Electronic Remittance Advices
Reduces accounts receivable errors and
administrative costs.
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Provides prompt delivery of electronic
remittance advices to providers — usually
before paper copies arrive.
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We encourage providers to contact their electronic
vendors and clearinghouses to learn more about
additional options available for ERA such as:
Manual and automated posting options.
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Single easy-to-read, printer friendly format for
multiple payers.
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Electronic Funds Transfer (EFT)
EFT is secure, efficient process for directly
depositing payments into the providers’ bank
accounts. Providers have immediate access
to funds.
Real Time Electronic Transactions
Many health care organizations, including health
care partners, payers, clearinghouses, software
vendors and fiscal intermediaries offer electronic
solutions as a fast, inexpensive and secure method
of automating business processes. Anthem has
electronic and web solutions, giving providers
access to patient insurance information before or at
the time of service, using the system of their choice.
Advantages
Allows providers to perform online transactions.
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Provides coverage verification before services
are provided.
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Collect copayments at the time of service.
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Streamlines claim management and reduces
payer calls.
Easy access to payer Explanation of
Benefits (EOBs).
Automated coordination of benefit
claims filing.
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Capability to quickly locate documents
for research and customer service.
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Image retrieval, eliminating loss of
misfiled documents.
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Support and staff training.
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Please download the ERA enrollment form from
anthem.com/edi.
Reduces rejections and denials due to
eligibility errors.
Provides mechanisms to automatically track
claim status and correct patient information
for future claims submission.
Register at Anthem Online Provider Services
Online Web Portal
Web-based transaction system for health care
partners. Participants with Anthem can easily
and quickly access pertinent patient information.
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To learn more about enrollment, password
resets and available features, contact your
support representative at 866-755-2680.
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Please download theEFT enrollment form from
anthem.com/edi.
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Many health care organizations, including
health care partners, payers, vendors
and fiscal intermediaries choose EDI as
a fast, inexpensive and secure method of
automating their business processes.
Features
270/271 Health Care Eligibility Benefit Inquiry
and Response – This “real time” transaction
provides information on patient eligibility,
coverage verification, and patient liability
(deductible, copayment, coinsurance).
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To learn more about enrollment, cost and
available features, please contact the EDI
Solutions Helpdesk at 800-334-8262 or visit our
website at anthem.com/edi.
276/277 Health Care Claim Status Request
and Response – Also real time, this
transaction indicates whether an electronic
claim has been paid, denied or in progress.
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Getting Connected
Providers can access these HIPAA
compliant transactions:
Clearinghouse or EDI software vendor
Clearinghouses and EDI vendors often have easyto-use web and automated solutions to verify
information for multiple payers simultaneously
through one portal in a consistent format.
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Contact your EDI software vendor or
clearinghouse to learn more about
options available.
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For connectivity options and file
specifications our Anthem EDI Companion
Guide is available at anthem.com/edi.
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Contact (EDI Specialist): EDI HELP DESK
Hours available: 8:00 a.m. - 4:30 p.m. ET
Telephone: 800-334-8262
Web address: anthem.com/edi
E-mail address: edi-ne@anthem.com