EDI Documentation

For facility providers: claim exclusions

The following institutional/hospital claims cannot be submitted electronically at this time:

  • Commercial payers
  • FEP when billing Tertiary payer COB claims
  • Out-of-State hospitals (Non-par) for Blue Cross, BCN and FEP (Note: Submit out-of-state claims to the home Blues Plan.)

Note: These claim exclusions reflect those listed in the current ANSI ASC X12N 837 & 835 Institutional Health Care Claim & Health Care Claim Payment/Advice Companion Document (PDF).

For professional providers: claim exceptions

The following claims cannot be submitted electronically at this time:

  • Blue Cross Blue Shield of Michigan, FEP and Blue Care Network Claims requiring hardcopy documentation
  • Blue Cross Blue Shield of Michigan, FEP and Blue Care Network tertiary claims
  • Blue Care Network status inquiry for secondary claims
  • FEP COB claims
  • Blue Cross Blue Shield of Michigan COB that are auto- or employment-related
  • Commercial secondary or tertiary claims submitted for payers denoted as "Print and Mail" on the Commercial Payer Listing (PDF).

Note: These claim exceptions reflect those listed in the current ANSI ASC X12N 837 & 835 Professional Health Care Claim & Health Care Claim Payment/Advice Companion Document (PDF).

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