Testing of new 5010 transactions is a process designed to allow submitters to verify
their data is compliant with the front-end and processes. It is each submitter’s
responsibility to utilize the process developed by Arkansas Blue Cross and Blue
Shield and its family of companies in order to avoid payment interruption.
Prior to moving a submitter’s claims file into production each submitter must complete
testing. The testing process is defined as the following;
Claims that are submitted for testing should be representative of the services that
you intend to submit to Arkansas Blue Cross and Blue Shield and its family of companies
after you are approved for production. Additionally, a variety of procedures should
be submitted for testing, as applicable to your specialty.
You must submit 5010 transactions in a continuous string.
If you do not submit a 5010 transaction in a continuous string, your file will not
- EDI trading partners must pass level 1 and level 2 testing. Only send errata versions.
- Level 1 testing consists of transmission and transaction integrity. In addition,
level 1 testing will validate the syntax compliance at the standard level.
- Level 2 testing consists of data integrity. This testing is related to implementation
guide requirements. Contractors will edit data related to required data elements,
relational data and validate code values such as qualifiers specific to a particular
- If an EDI submitter is using a billing service, clearinghouse, or vendor supplied
software to generate a certain transaction and that billing service, clearinghouse,
or software package has passed testing requirements for that transaction and is
using the same program/software to generate the transaction for all of their clients,
it is the contractor’s discretion as to whether the contractor tests all clients
of the billing service, clearinghouse, or software vendor on that transaction.
- Submit a minimum of 25 claims per practitioner.
- Only professional or institutional claims can be submitted in a file (ISA – IEA).
Please do not submit a file with a mixture of professional and institutional claims.
Files received with a mixture of professional and institutional claims will be rejected.
- Once you have submitted a file for testing, it is each submitter’s responsibility
to review all reports returned to you. Standard syntax testing validates the programming
of the incoming file and includes file layout, record sequencing, balancing, alpha-numeric/numeric/date
file conventions, field values, and relational edits. Test files must pass 100 percent
of the standard syntax edits before production is approved.
- IG Semantic Data testing validates data required for claims processing, e.g., procedure/diagnosis
codes, modifiers. A submitter must demonstrate, at a minimum, a 95 percent accuracy
rate in data testing before production is approved where, in the judgment of Arkansas
Blue Cross and Blue Shield and its family of companies, the vendor/submitter will
make the necessary correction(s) prior to submitting a production file.
- Monitor the appropriate response files after each test submission to determine format
and/or data elements to be corrected and re-tested. You will not receive any other
form of notification for initial test results.
On occasion, there are some direct electronic submitters that may not have a large
volume of patients to test with. Below are some suggestions and tips to assist you
in achieving production status.
- For those providers who do not have a large patient base, we suggest that you compile
some claims that have been previously submitted and paid in the 4010A1 format. Convert
the 4010A1 previously paid claims into a 5010 format and submit those claims for
- Create 25 claims for different types of services. Test claims are not routed to
production nor processed for payment.
- You can use one or two patient’s insurance information on all of your test claims.
You do not have to submit 25 different patients on your test claims.