With Blue Cross EDI Platform Moving to Availity This August, Consider Your Options Carefully

In mid-April, Blue Cross Blue Shield of Michigan (BCBSM) announced that they will move their electronic data interchange services, known as EDI, to Availity®, effective August 2023. Prior to this transition, the MAC Insurance Relations team recommends researching and considering your options thoroughly moving forward.

Our preliminary research shows that after this transition, for those offices using BCBSM’s EDI platform, only the following insurances will be able to bill electronically (without a fee):

  • Blue Cross commercial (including the Federal Employee Program)
  • Medicare Plus Blue (BCBSM’s Medicare Advantage PPO plan)
  • Blue Cross Complete
  • Blue Care Network commercial
  • BCN Advantage (BCN Medicare Advantage HMP and POS plans)

These “sponsored transactions” are included in all of Availity’s plans, including the Base Plan, which has no monthly fee.

However, there are fees for many payers, including Medicare, Medicaid, Priority Health, and other insurances commonly encountered in chiropractic offices across the state. To continue using Availity to submit to these payers, offices will have to upgrade their plan. Upgraded plans range in cost from as little as $35 for 250 “premium” transactions per month, to as high as $400/month for 10,000 transactions.

Moving Forward

Chiropractors who currently submit HIPAA EDI transactions to Blue Cross for payors other than those listed above will need a new method to submit those transactions moving forward. Options include:

  • Paper billing claims for all remaining insurances
  • Sticking with Availity and purchasing one of their updated plans
  • Selecting a new clearinghouse (for information on the factors to consider when choosing a new clearinghouse, click here)

MAC – Infinedi Partnership

If you decide that selecting a new clearinghouse is the right decision for your clinic, you should be aware that the MAC has partnered with and secured discounted pricing from Infinedi, a leader in the Electronic Data Interchange (EDI) world and amazing supporter of the chiropractic profession.

Infinedi is a national leader with partnerships with many chiropractic associations. Their goal is to make your experience of submitting electronic claims as efficient and cost-effective as possible. Unlike other payer-sponsored “free” or deeply “discounted” options offered, Infinedi receives its payments from the provider – not the insurance companies. Furthermore, Infinedi is the sole analytical advocate for the Chiropractic Future Strategic Plan, which is developing a profession-owned data-repository for chiropractic research and future outcomes.

To request a personalized demo, click here. For more information, contact the MAC at info@chiromi.com or (517) 367-2225.

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