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PROVIDER eSOLUTIONS

Provider eSolutions

Provider eSolutions (formerly EDI Services) provides support to healthcare providers and practice management and electronic health record (EHR) vendors, helping to ensure that electronic transactions for our members are processed quickly and efficiently. We support all HIPAA-compliant transactions, including:

  • Eligibility and Benefits
  • Claims
  • Referrals
  • Remittance Notices

See eSolutions for Healthcare Providers for information about ways to conduct these transactions with Blue Cross.

In addition, Provider eSolutions promotes and supports the secure exchange of clinical data through standard transactions such as Direct Secure Messaging. Current clinical data exchange opportunities include:

Care Alerts

Care Alerts notify providers when an attributed patient has an emergency room visit or is admitted to or discharged from a hospital.

Primary care physicians, physician assistants and nurse practitioners can subscribe to receive the types of alerts (emergency room visit, hospital admission, and/or hospital discharge) they want to receive about their patients and select how they'd like to receive them (Direct message*, secure email, and/or fax). 

ProviderAccess Administrators: Enroll Providers Online for Care Alerts

  1. Log in to ProviderAccess.
  2. Click "Users" in the upper right corner of screen.
  3. Select the tab labeled, "Care Alerts." 

*Direct messages are similar to email but are delivered right to your electronic health record (EHR) system securely and almost immediately. Contact your EHR vendor to obtain a Direct messaging address if you do not already have one.

Benefits of Receiving Care Alerts

  • Patient care management is improved through:
    • Awareness of patient care received outside your office.
    • Identified opportunities to close patient gaps in care.
    • Better transition of care after hospital discharge.
  • Potential improvement in these performance measures:
    • Plan All-Cause Readmissions (Hospital Readmissions)
    • Medication Reconciliation Post Discharge for Blue Advantage® Members

*Direct messaging is a technology standard required by the Office of the National Coordinator (ONC)-certified EHR solutions for the secure exchange of clinical information via the Internet. 

 

Electronic Medical Records (EMRs)

MedConnect customers have the option to send medical records to Blue Cross free of charge. Sharing this clinical information can help you and our members in many ways:

  • Reduce the level of administrative burden and coding required on claims.
  • Identify patients with clinical conditions who should be enrolled in Blue Cross health and wellness programs.
  • Improve clinical alerts and information regarding gaps in patient care.
  • Reduce or eliminate the need to do manual chart extractions.
  • Impact performance in physician value-based payment programs.

If you have questions about MedConnect, contact your Provider Solutions Consultant at Ask-EDI@bcbsal.org or 205-220-6899. If you are a MedConnect customer, contact MedConnect for more information about this service.

MedConnect is an independent company.

Lab Clinical Data Exchange

Many participating laboratories send lab results to Blue Cross and Blue Shield of Alabama. This information is used in efforts to control chronic disease and guide behavioral changes for improved wellness. Lab results are also used for provider value-based incentive programs and may result in increased payment for achieving clinical effectiveness metrics.

View a list of the labs that currently send us lab results.

Information for Vendors/Clearinghouses