Anthem EDI Edit for 837 Professional Independent Lab Claims

December 2017~

Effective December 8th, Anthem electronic data interchange (EDI) will be implementing a new edit related to independent laboratory claims. The insurer intends for this update to reduce processing time and manual intervention for lab claims.

The update requires a referring provider to be indicated when the place of service is billed as an independent laboratory. If the referring provider is not indicated, the claim will reject. By implementing this edit, Anthem says it will ensure the appropriate data is submitted per the HIPAA Implementation Guide and Blue Cross Blue Shield Association (BCBS) ancillary filing guidelines.

The following edit became effective as of December 8th, on the provider EDI level II report:

  • 60117- Referring Provider, qualifier DN loop 2310A, must be present when Place of Service, CLM05-1, is 81, Independent Laboratory.

For more information, see Anthem’s EDI page.



Source(s): Anthem Blue Cross and Blue Shield Network Update;