Please follow the Enrollment Instructions below to become an electronic submitter for Blue Cross Blue Shield Excellus.

Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completed, signed and returned to the Lifetime Healthcare Co office prior to initiation of electronic claims submission or inquiry.

Univera

1. Electronic Consent (Trading Partner Agreement)

2. Schedule C Remit

Excellus

1. Electronic Consent (Trading Partner Agreement)

2. Schedule C Remit

To obtain the forms above, please download them from:
www.lifethc.com/vendors

If you have any questions regarding any of the documents in this package, please call the Lifetime Healthcare Co EDI Technology Support Center at 1-877-843-8520.

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.

Trading Partner Agreement

Please complete the Practice Information Section:

• Enter your practice name, address, and contact information

• Enter your Practice NPI, and Tax Id number

• Select Yes if you are using a Billing Service

• Under the question for ANSI 835’s check Yes

• For the Software Vendor enter the information for the software or vendor that creates your 837 files you need ClaimShuttle to transfer for you. If you have paid for our SolAce billing software please call our support line for our SolAce software information.

• New Applicants may leave the Submitter ID and Effective Date blank

• Signature of Physician or authorized contact

Schedule C

• This form is only to be completed by Providers using a Billing Agent.

Schedule CR

• This form is only to be completed by Providers using a Billing Agent.

Schedule D

Please complete the Provider/Agent section on the last page of this document

Please Note: If a representative from Excellus calls you and asks about your mode of communication please let them know you will be connecting via modem/dial-up.

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Mail the enrollment forms reflecting original signatures to:

Univera Healthcare EDI Solutions

P.O. Box 211256
Eagan, MN 55121

OR

Excellus Health Plan, Inc.
EDI Solutions
P.O. Box 21146
Eagan, MN 55121

It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

After processing, a confirmation will be faxed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the Lifetime Healthcare Co EDI Technology Support Center at 1-877-843-8520.

Testing

Once you have received your Submitter ID and password from Univera or Excellus, please call the ClaimShuttle Support Team and set an appointment for a Mailbox setup and Test Transmission.

Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.