Supported transactions and enrollment
| Transaction | Status |
|---|---|
| Eligibility & benefits (270/271) | Supported |
| Claim status (276/277) | Not supported |
| Professional claims (837P) | Supported |
| Institutional claims (837I) | Supported |
| Dental claims (837D) | Not supported |
| Electronic remittance (ERA 835) | Enrollment required |
| Electronic funds transfer (EFT) | Enrollment required |
| ERA + EFT combined | Not supported |
| Coordination of benefits (271) | Not supported |
| Attachments (275) | Not supported |
Other payer IDs and names
- Also listed as Medicare Blue HMO PPO
Enrollment requirements
- Electronic remittance (ERA 835): multi step enrollment, typically takes weeks
Plan the electronic workflow
- Use 270/271 for eligibility and benefits checks, but handle coordination-of-benefits information through another process because this payer does not support COB 271.
- Submit medical claims using 837I or 837P; do not route dental claims through this payer’s supported electronic claim options.
- Complete payer enrollment before relying on EFT or ERA 835, and track enrollment status in your billing workflow.
- If ERA is unavailable before enrollment, plan manual remittance posting; this payer does not offer a combined ERA and EFT transaction.
- Use another payer process for claim status, attachments, and other unsupported transaction types.
Common questions
Can I submit both institutional and professional claims electronically?
Yes. This payer supports institutional claims through 837I and professional claims through 837P, but not dental claims through 837D.
Can I check eligibility and benefits electronically?
Yes, eligibility and benefits checks are supported through 270/271. Coordination-of-benefits 271 transactions are not supported and require another process.
How can I receive ERA and EFT from this payer?
Complete payer enrollment before using EFT or ERA 835. Both are supported after enrollment, but this payer does not support a combined ERA and EFT transaction.
Does this payer support electronic claim status or attachments?
No. Claim status transactions 276/277 and attachments 275 are not supported, so use another payer process for those tasks.
Run this payer inside Hero EMR
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