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Get Empire Blue Cross Blue Shield EDI Registration Form 2012

D Section I. Add Section III. Action (choose one) Change Delete Section II. Line of Business (choose one) BlueCross BlueShield Commercial EDI Transactions (check all that apply, Commercial allows 837 claim and EDI Reports ONLY) 837 Claim 278 Pre-certification & Specialty Care Referral 835 Remittance (one receiver per provider) 834 Benefit Enrollment & Maintenance (Benefit administrators only) 270/271 Eligibility Inquiry & Response 276/277 Claim Status & Response Section IV. Network .

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