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EDI Enrollment
Our Web-based EDI (Electronic Data Interchange) application will give you the ability to review the results of your EDI file processing online, the same day the file is transmitted. You will be able to:
- View file processing statistics and transaction results, including benefits, enrollment adds, changes, and terminations.
- Correct errors online and resubmit transactions for processing.
- Release files for production processing.
- Create customized reports.
Independence Blue Cross supports HR-XML, ANSI 834 and METS file formats for submitting EDI enrollment information on employer groups with 500 or more commercial contacts. Compare the features of each to gain insight into which format may be right for your business.
After you review the electronic options, please contact your IBC Marketing Representative to initiate an EDI discussion with our eBusiness Team.
Download our Guide to Your Electronic Options
HR-XML
HR-XML stands for Human Resource – Extensible Markup Language. This open data exchange standard was developed by the HR-XML consortium to enable the automation of Human Resource related transactions. Using HR-XML, any company can transact with another without having to establish, engineer, and implement an interchange mechanism to do so.
Features of HR-XML
- Real-time transmissions: As a transaction is entered into your Human Resource system, it is sent within seconds to Independence Blue Cross.
- Supports individual transactions or batch files.
- Transactions are confirmed immediately.
- Easily transfer your HR-XML content from another health insurer to Independence Blue Cross.
- Extensive testing ensures successful implementation, which is generally accomplished in 3-6 months. (See the EDI Testing section later in this Employer Reference EDI Link).
For more information on the detailed HR-XML format, visit: hr.xml.org.
Our Companion Guide supporting the implementation of the HR-XML Benefit Enrollment v2.0 Schema is not available at this time. Please contact your Marketing Representative for additional documentation.
ANSI 834
Features of ANSI 834
- Transactions are batched and sent as transactional or full files.
- Confirmation responses are sent same day.
- Easily transfer your ASC X12N 834 enrollment information from another health insurer to Independence Blue Cross.
- Extensive testing ensures successful implementation, which is generally accomplished in 3-6 months. (See the EDI Testing section later in the EDI Enrollment Link).
- Compliant with HIPAA (Health Insurance Portability and Accountability Act of 1996) specifications for electronic exchange.
The following links provide information about the Independence Blue Cross ANSI 834 Implementation.
ANSI X12 834 Companion Guide (Transactional Files)
ANSI X12 834 Companion Guide Addendum (Full Files)
For more detailed information on ANSI 834 refer to www.wpc-edi.com/hipaa/hipaa-40.asp.
METS
METS is short for Membership Electronic Transaction System. METS is a proprietary system developed by Independence Blue Cross for transferring enrollment and eligibility content from our clients through electronic transfers and feeds.Features of METS
- Confirmation responses are sent same day.
- Implementation specifications and procedures provided by Independence Blue Cross.
- Offers flexibility to tailor customer transaction processing and reporting according to specific needs.
- Quick deployment time — typically 2-4 months. (See the EDI Testing section later in the EDI Enrollment Link).
The following link provides more detailed information about the METS Implementation.
The implementation documents listed below will be provided for each electronic file format:
Group Number/Coverage Code Matrix — Sample
Implementation Plan/Timeline — Sample
EDI testing
During implementation for any EDI file format, your Independence Blue Cross deployment team will work with you to create a comprehensive test plan to ensure the success of your electronic communications with us. Testing will include all applicable compliance and format testing. In addition, we will run a number of transactions to simulate a true production environment before your first live file is ever transmitted. The more scenarios we test, the greater the likelihood of quality and accuracy.
The following scenarios represent a sampling of test cases. Some may not be applicable to your plan design.
Add Single Contract
Add Husband and Wife Contract
Add Parent and Child Contract
Add Parent and Children Contract
Add Family Contract
Add Drug Product
Add Dental Product
Add Vision Product
Add Spouse Dependent
Add Child Dependent
Add Newborn Child Dependent
Add Overage Student Dependent
Change Subscriber’s Last Name, Address, and Phone Number
Change Electronic Identification Numbers — Same Product
Change Electronic Identification Numbers — Different Product
Add Additional Product Line of Business (Subscriber only)
— Ancillary Products (Drug, Dental, Vision)
Add Additional Product Line of Business (All Dependents)
— Ancillary Products (Drug, Dental, Vision)
Term Single Contract
Term Husband and Wife Contract
Term Family Contract
Term Non-HMO Contract — No ancillary products
Term Non-HMO Contract — With ancillary products
Term HMO Contract and NON-HMO ancillary product
— (2 different electronic identification numbers)
Term Ancillary Product only
Term Multiple Products
Term Spouse
Term Child
Term Children
Term Spouse and Child(ren)
Term Overage Student
Making the right decision
When it comes to making the right decision for your company’s communications needs, choice is a good place to start. And Independence Blue Cross is here to help you take it from there. We can help analyze and explain your options to key players in your organization. We’ll make sure your benefit information is kept secure and transmitted with accuracy — whether you submit to us daily, weekly, or on your timetable. You’ll feel confident about Choosing Blue every step of the way.