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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 use Direct Secure Messaging* to notify primary care providers when one of their attributed patients seeks care at an emergency room or is admitted to or discharged from the hospital.
 
Direct messages are similar to email but are delivered right to your electronic health record (EHR) system almost immediately. 

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 performance for incentive scoring, including two measures that may be factored into scoring for 2019 incentives:

  • Avoidance of Hospital Readmissions
  • Medication Reconcilliation Post Discharge for Blue Advantage® Members

ProviderAccess Administrators: Enroll Providers Online for Care Alerts

  1. Contact your EHR vendor to obtain a Direct messaging address, if you do not already have one.
  2. Log in to ProviderAccess.
  3. Click "Users" in the upper right corner of the screen.
  4. Select the tab labeled, "Care Alerts," and enter the provider's Direct address. 

*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. 

The information contained in the Care Alert is provided by the applicable facility contained in the notification. The information contained is strictly for notification purposes only and is not intended to be used to determine the course of treatment for a patient. Blue Cross and Blue Shield of Alabama makes no representation of any kind, expressed or implied, regarding the accuracy of the information contained in the notification.

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