Enroll in Electronic Data Interchange

Electronic transactions are exchanged through an approved Electronic Data Interchange (EDI) clearinghouse or with Blue Shield of California directly through secure file transfer protocol. Companion Guides for Blue Shield and Blue Shield Promise Health Plan are available for download at EDI Companion Guide.

Read below for the steps to use a clearinghouse.

Using an EDI clearinghouse

Approved EDI clearinghouses typically offer a variety of services that can help reduce your administrative costs by increasing your office efficiency.

Steps to enroll with a clearinghouse

To exchange electronic transactions using an EDI clearinghouse, follow these simple instructions:

Step 1

Choose an approved EDI clearinghouse from the list. Note: Choose a clearinhouse that is approved for the specific transaction to be exchanged.

 Download the list of approved clearinghouses (PDF, 89 KB)

Step 2

Contact the selected EDI clearinhouse to enroll and begin exchanging electronic transactions.

Step 3

Enrollment in Electronic Remittance Advice and Electronic Funds Transfer (ERA/EFT)
After enrollment with an approved clearinghouse is complete, a registed Provider Connection Account Manager should add or update ERA and/or EFT enrollment online using the following steps:

1. Log in to their Provider Connection account.
2. Go to Account Management.
3. Go to the Provider and Practitioner Profiles section.
4. Once in the provider demographics dashboard, if there’s more than one provider organization, select the right TIN and then click “Search” to refresh the page.
5. Next, locate the Remittance & Payments tab and submit vendor preference. In that same tab, you can also enroll the TIN organization in EFT.

A provider organization NOT registered on Provider Connection at blueshieldca.com/provider must download the ePayments Provider authorization form (PDF, 173 KB). Complete one authorization form per bank account with EFT and/or ERA information. Include an authorized signature on the request (that of a practitioner, corporate office, or an authorized manager). Attach the required documentation as outlined in the ePayment Provider authorization form and fax the form to (866) 276-8456.

Blue Shield will send confirmation of your enrollment in electronic payments within 30 business days. Electronic Remittance Advice are available in one business day and funds are deposited within two business days after your claims finalize.

Connecting directly with Blue Shield of California

Consideration for organizations to exchange electronic claim transactions with Blue Shield of California through secure file transfer protocol (SFTP) using a direct connection with Blue Shield is based on the following, among other factors, such as business need:

• Submit more than 1,500 claims per month
• Update and maintain their EDI software
• Ensure at least 95% acceptance with HIPPA compliant transactions
• Have the ability to receive and utilize EDI acknowledgement, 277CA (claims acknowledgement), and ensure rejected records are corrected and resubmitted

Real-time eligibility and benefit and claim status inquiries are exchanged over secure http/s protocols.

Steps to enroll for a direct connection to Blue Shield

To establish a direct SFTP connection or enable exchange of additional types of EDI transactions with Blue Shield of California, follow these simple instructions:

Step 1

If you do not currently have a Trading Partner Agreement with Blue Shield of California, you must complete and return the Trading Partner Agreement to the email address listed below.

 Download the Trading Partner Agreement form (PDF, 59 KB)

Step 2

Complete and return all parts of the Trading Partner enrollment packet via email to TPImplementation@blueshieldca.com.

 Download the Trading Partner enrollment packet (PDF, 130 KB)

Current Trading Partners requesting updates to their IP address information should download and complete the SFTP connectivity detail form (PDF, 105 KB).