Alaska Blue Cross Blue Shield
Please follow the Enrollment Instructions below to become an electronic submitter for Alaska Blue Cross Blue Sheild.
In order to be able to submit claims electronically to AK Blue Cross Blue Shield, you must first go to onehealthport.com and Register for an OHP User ID (if you do not have one). You may click on this link to launch the One Health Port Registration Page: http://www.onehealthport.com/register/index.php
Once you receive your OHP User ID, you will then be able to access the forms below from your OHP account.
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. Secure Transport Enrollment Form
2. 835 EDI Authorization Form (for Electronic Remittance Advice)
If you have any questions, please call the BCBS EDI Technology Support Center at 1-800-435-2715
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.
Secure Transport Enrollment Form
Trading Partner Information Section 1
Enter your Business/Practice or Provider Name
Enter your demographic information
Enter your Tax ID and NPI number
Enter the name of the main contact person for your office and his/her phone and fax numbers, as well as a valid email address
Enter your OHP User ID
For Software Vendor please enter the information for the software or vendor that creates your 837 files you need ClaimShuttle to transfer for you. If you paid for our SolAce billing software please call our support line for our SolAce software information.
For Electronic Format select ANSI X12
If given an option to choose 4010 or 5010, please choose 5010
Enter the names and email address of the person(s) who will be doing your billings. (You may leave the OHP User ID blank if they do not have one)
Please place a check mark next to 835 and 837 Institutional or Professional
For the 997 or 999 Acknowledgment please select "Yes"
For the default delimiters please select "Yes"
The rest of the information on this form is for informational purposes. You do not need to do anything with the remaining pages.
835 EDI Authorization Form (Electronic Remittance Advice)
Enter your Group/Facility or Provider Name
Enter your address and phone number
Enter the name of the main contact person in your office
Enter your e-mail address
Enter your Tax ID and Provider NPI
Select "Yes" if you use the same Tax ID for other groups, facilities, or providers
By doing so the 835 will include payments for all providers who share this Tax ID
If you use a Billing Service/Clearinghouse fill out this section, if not please skip.
Enter the Billing Service's Name, Submitter ID, and Demographic information
By signing this application, the Provider agrees to receive their remittance advice electronically, either directly or through a Billing Service.
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:
Blue Cross Blue Shield of AK P.O. Box 327 M/S 481 Seattle WA 98111-0327
Or for Faster Service Fax to: 425-918-4234 Or email to: EDI@Premera.com
Please Note The EDI Authorization Form for Electronic Remittance Advice must be submitted by mail with an Original Signature; however, the Secure Transport Enrollment Form may be mailed, faxed, or e-mailed.
It is very important that you complete and return the entire enrollment appliacations as described above. Incomplete applications 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 three to five business days from the date of receipt. (Remember that mailing time can take as much as five days.)
After processing, a confirmation will be emailed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the Technology Support Center toll-free at 1-800-435-2715.
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 to BCBS.
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.