Electronic Nonclaims, Real-Time Transactions
We offer providers an electronic real-time option for member eligibility, benefit information and claims status. This technology lets you integrate the submission of eligibility and claims status transaction inquiries and the processing of the subsequent transaction response into your patient registration system.
We currently support commercial messaging software called WebSphere MQ. System requirements for communicating with the BCBSM network are:
Network connectivity will typically be established via one of following options:
- Virtual Private Network (Using MQ over VPN)
- Internet Connectivity (Using SOAP/HTTPS) — Available starting Jan. 1, 2013 as per CAQH Mandate
Required software component:
IBM WebSphere MQ (Server), IBM WebSphere MQ Client, or software with equivalent functionality:
Supported releases of WebSphere MQ range from V6.0 to V188.8.131.52 (current).
Equivalent software may include:
- WebSphere Application Server
- WebSphere MQ Java Messaging Service. This software component, which includes an Application Programming Interface, provides the infrastructure for developing applications that can communicate with the BCBSM Real-Time 270/276/278 system.
Supported operating systems include:
- Linux for Intel
- Linux for zSeries
- Windows XP, Server2003
For further information regarding eligibility and claim status transactions:
- Refer to the HIPAA mandated ANSI ASC X12N Implementation Guides and Addenda from the Washington Publishing Company website.
- Refer to CAQH Core Eligibility and Claim Status Operating Rules documents from the CAQH Website.
- Download the BCBSM HIPAA EDI Companion Document: ASC X12N 270/271 (005010X279A1) Health Care Eligibility Benefit Inquiry and Response (PDF).
- Download the BCBSM HIPAA EDI Companion Document: ASC X12N 276/277 (005010X212) Health Care Claim Status Request and Response Companion Document (PDF).
- Download the BCBSM HIPAA EDI Companion Document: ASC X12N 278 (005010X217) Health Care Services Review and Response Companion Document (PDF).
- For technical information or other questions, please call 1-800-542-0945 or email firstname.lastname@example.org.