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 After January 1, 2012, version 4010A1 is no longer valid.
Trading Partner Agreement
Trading Partner Registration Form
EFT and ERA Registration
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 EnrollHub™ , a Council for Affordable Quality Healthcare (CAQH) Solution™, a secure electronic ERA/EFT registration platform. CAQH is an independent company that provides an electronic registration tool on behalf of BlueChoice HealthPlan. This tool will help eliminate the need for paper registration, reduce administrative time and costs, and allow the user to register with multiple payers at one time.
Providers previously registered with BlueChoice HealthPlan Medicaid to receive combined ERA/EFT or EFT (only) will register with EnrollHub 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.
Beginning October 12, 2015, Trading Partners will be required to use our new ERA (835) online registration process to enroll for ERA only (i.e., ERA but not EFT). You can continue to use the CAQH online enrollment tool to enroll a provider for ERA/EFT (both) or EFT (only) and to manage EFT account changes or cancellations.
Paper/faxed/emailed ERA (835) forms received after 4:30 pm Eastern time on September 25, 2015, will not be processed and a request to submit directly using the new online ERA registration process available after October 12, 2015, will be returned to the request submitter when possible.
Claims Processing Information
4010A1 HIPAA Companion Guide
The EDI Solutions Help Desk is available Mondays - Fridays from 8 a.m. to 4:30 p.m EST.
Find out more about Electronic Data Interchange.