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Learn moreElectronic Connectivity (EDI)
EDI Documentation for Professional Providers: Claim Exclusions
The following claims cannot be submitted electronically at this time:
- BCBSM, FEP and BCN Claims requiring hardcopy documentation
- BCBSM, FEP and BCN tertiary claims
- Commercial secondary or tertiary payer claims
- BCN status inquiry for secondary claims
- FEP COB and status inquiry claims
- BCBSM COB that are auto- or employment-related
- BCBSM rural health supplemental claims where the primary payer processed as a facility claim and the supplemental portion needs to be processed by BCBSM as professional. The primary payer (Medicare Part A) paid an amount higher than the original total charge.
Note: These claim exclusions reflect those listed in the current ANSI ASC X12N 837 & 835 Professional Health Care Claim & Health Care Claim Payment/Advice Companion Document (PDF).
