For providers: What are my options for real-time electronic transactions?
Who is this for?
If you’re interested in getting patient information more efficiently, this explains the electronic real-time solutions we support.
Web-DENIS and our automated phone system aren't the only ways to get patient eligibility and claims status. We support two alternatives that are faster and more efficient: IBM® MQ and SOAP/HTTPS. You can use them for:
- Eligibility and benefits (270/271 transactions)
- Claims status (276/277 transactions)
Both options make it possible for different programs to communicate in real time with our systems using EDI. That means you get information within seconds that can be integrated into your practice management software and patient registration systems.
Here’s what you need to know about each option. Whichever one you choose, you’ll need to complete the steps outlined in How to use EDI to exchange information with us electronically before you can send and receive files.
Connecting via VPN using IBM® MQ
IBM WebSphere® MQ, now just called IBM MQ, is messaging software. It can be a good option for larger practices and facilities that see a lot of patients. To use IBM MQ, you’ll need a virtual private network, or VPN. We also support other MQ clients.
SOAP is a messaging protocol also used for real-time electronic transactions, except the communication takes place over a secure internet connection (HTTPS). Using SOAP can be a good option for practices and facilities that don’t have IBM MQ and a VPN. This guide will help you get started: EDI Real Time SOAP/HTTPS Services (PDF).
Additional EDI resources
- HIPAA mandated ANSI ASC X12N Implementation Guides and Addenda from the Washington Publishing Company website.
- CAQH Core Eligibility and Claim Status Operating Rules documents from the CAQH website.
- BCBSM HIPAA EDI Companion Document: ASC X12N 270/271 (005010X279A1) Health Care Eligibility Benefit Inquiry and Response (PDF).
- BCBSM HIPAA EDI Companion Document: ASC X12N 276/277 (005010X212) Health Care Claim Status Request and Response Companion Document (PDF).
- BCBSM HIPAA EDI Companion Document: ASC X12N 278 (005010X217) Health Care Services Review and Response Companion Document (PDF).