18NW2095 R08/15 Blue Cross and Blue Shield of Louisiana is an independent licensee of the Blue Cross and Blue Shield Association and
incorporated as Louisiana Health Service & Indemnity Company.
The ERA service enables Blue Cross and Blue Shield of Louisiana to provide you with an electronic remittance advice,
which is a statement of your claims payments in an electronic format. A copy of this form is available online at
www.bcbsla.com/providers >Electronic Services >Clearinghouse.
Provider Name – Complete legal name of institution, corporate entity, practice or individual provider
Street Address – The number and street name where a person or organization can be found
City – City associated with provider address field
State/Province – The two character code associated with the State/Province/Region of the applicable country
ZIP Code/Postal Code – System of postal-zone codes (zip stands for “zone improvement plan”) introduced in the
U.S. in 1963 to improve mail delivery and exploit electronic reading and sorting capabilities
PROVIDER IDENTIFIERS INFORMATION
Provider Federal Tax Identification Number (TIN) / Employer Identification Number (EIN) – A Federal Tax
Identification Number, also known as an Employer Identification Number (EIN), is used to identify a business entity
National Provider Identifier (NPI) – A Health Insurance Portability and Accountability Act (HIPAA) Administrative
Simplification Standard. The NPI is a unique identification number for covered healthcare providers. Covered
healthcare providers and all health plans and healthcare clearinghouses must use the NPIs in the administrative
and financial transactions adopted by HIPAA. The NPI is a 10-position, intelligence-free numeric identifier (10-digit
number). This means that the numbers do not carry other information about healthcare providers, such as the state
in which they live or their medical specialty. The NPI must be used in lieu of legacy provider identifiers in the HIPAA
Trading Partner ID – The provider’s submitter ID assigned by health plan, the provider’s clearinghouse or vendor.
PROVIDER CONTACT INFORMATION
Contact Name – Name of a contact in provider office for handling ERA issues
Title – Title of the contact person
Telephone Number – Associated with the contact person
Email Address – An electronic mail address at which the health plan might contact the provider
Fax Number – A number at which the provider can be sent facsimiles
ELECTRONIC REMITTANCE ADVICE INFORMATION – Provider preference for grouping (bulking) claim payment
remittance advice – must match preference for EFT payment.
Provider Tax Identification Number (TIN) – see explanation under Section 2 above.
National Provider Identifier (NPI) – see explanation under Section 2 above.
Method of Retrieval – The method in which the provider will receive the ERA from the health plan (e.g., download
from health plan website, clearinghouse, etc.)
Note: BCBSLA groups all Electronic Remittance Advices by NPI, if available. When NPI is not available, ERAs are
grouped by TIN.
Guide to Completing the
Electronic Remittance Advice
(ERA) Enrollment Form