Please follow the Enrollment Instructions below to become an electronic submitter for Washington Blue Cross Premera.

Instructions on Enrolling for a Submitter ID

• To enroll for a Submitter ID with WA Blue Cross: Premera please follow the instructions below:

  • Call 1-800-435-2715, select option 1 and let the EDI Representative you speak to know that you would like for them to fax or email you an Enrollment Packet for electronic claims submission. If you would like to receive your EOBs electronically in ClaimShuttle please also let them know that you would also like for them to send you the form for Electronic Remittance Advices. If they ask if you will be receiving the Advices Directly please say “Yes”

  • The instructions for the form they will send you are located below for your convenience.

Once you receive your Submitter ID, User ID, and Password for WA Blue Cross you can call us at 602-439-2525 for mailbox setup assistance and test file transmission assistance.

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.

5010 Enrollment Form

Trading Partner Information

• Enter your Provider/Group or Facility Name

• Enter the demographic information for your office

• Enter your Tax ID and NPI

• New EDI Submitters Skip the question that asks for a current EDI Submitter ID

• Enter the name, title, phone, fax, and email address of the main Contact Person for your office

• Enter your One Health Port (OHP) User ID

• For software vendor name enter: the information for the software or vendor that creates your 837 files you need ClaimShuttle to transfter for you.

• If you have paid for our SolAce billing software please call our support line for our SolAce software information.

• Enter the names and user IDs for anyone in your office that will submit claims or retrieve reports

Section 1: Transactions

• Check the boxes for the transactions you will be submitting/receiving

  • 837 Health Care Claim Professional and/or

  • 837 Health Care Claim Institutional and

  • 835 Health Care Claim Payment/Advice

Section 2: Which Report Format would you prefer?

• Select Text

Section 3: Skip this section

Section 4: Select Yes, You will be using the default delimiters

Please Skip Sections 5-7

Section 8:

• Please Select “Version 5010 Files Only”

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Send the completed enrollment forms to:

P.O. Box 327 EDI MS-481
Seattle, WA 98111-0327

Or Email to: edi@premera.com

Or Fax to: 425-918-4234

It is very important that you complete and fax 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, Call 1-800-435-2715, and select option 1.

Testing

Once you have received your Submitter ID and Password from Anthem, 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 or payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.