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

Required Documents for those applying for new Submitter ID's

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

1. Trading Partner Agreement (will be emailed to you after you've submitted the ECR Form)

2. Electronic Connectivity Request Form:

3. Electronic Remittance Advice Agreement

If the links above do not work properly, you can download them from:
www.bcbsnc.com

If you have any questions regarding any of the documents in this package, please call the BCBS EDI Technology Support Center at 1-888-333-8594.

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

Page 1: Enter today's date and your Business/Practice or Provider Name.
Page 10: Please complete your mailing information.
Page 12-13: Please complete the Trading Partner section of this page.

Electronic Connectivity Request Form

• Please enter your Business/Practice or Provider Information.
• Please 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.

• For Connectivity Method please select HTTPS and today's date for the following:
• 837I or 837P (I = Institutional P = Professional)

• Please Sign and Date the bottom of the form.

Electronic Remittance Advice ERA Authorization Agreement

• Please enter your Business/Practive or Provider Information
• Please enter your Tax ID and NPI
• Please enter in your contact information
• Enter your NPI and check the box for "Direct"
• Please enter the Software Vendor Information for the Vendor that you use to create your 837's
• Check the box for New Enrollment
• Print, Sign and Date. For effective date enter today's date
• Press Submit

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Please fax the forms to: 919-765-7101

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.

After processing, a confirmation will be faxed to you as notification to begin filling claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the Technology Support Center toll-free at 1-888-333-8594.

Testing

Once you have received your Submitter ID and Password from BCBS, 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.