Electronic Data Interchange (EDI)

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ANSI ASC X12N 5010 Specifications
These documents are in portable document format (PDF) and may be downloaded from this website.
Companion Guide (PDF)
FEP 837 Health Care Dental Claim Companion Document (PDF)
Compliance Statement
This statement advises providers of the efforts of Arkansas Blue Cross and Blue Shield to address the administrative simplification provisions of HIPAA.
Connectivity/Communications (Moveit DMZ)
Moveit DMZ Transition Form (PDF)
Moveit DMZ User Manual (PDF)
Contact EDI Services
This section contains contact information.
Electronic Claims Testing
This information will help lead you through the process you must follow to become approved for electronic claims submission in the new HIPAA-compliant format.
EDI Report User Guide (PDF)
Electronic Data Interchange:
Private Business Transaction Companion Document (PDF)
This document provides additional guidance concerning the segments/data elements necessary to successfully process HIPAA-compliant ANSI X12N version 5010 270/271, 276/277 and 278 transactions for private business members.
WPC-EDI.com
This link will take you to the WPC electronic data interchange health care transactions site. This site will contain the ANSI X12 implementation guidelines that can be downloaded.
EDI Forms
All forms must be signed and returned to EDI Services via mail or fax. These forms are in portable document format (PDF) and allow you to complete them online, print, sign and mail or fax to the appropriate address/fax number.
APII Enrollment Form (PDF)
This form is to be used by providers who are participating in the APII project and currently do not have AHIN access.
Electronic Remittance Advice (ERA) (PDF)
Submitter Information Update Form (PDF)
Trading Partner Agreement (TPA) (PDF)
Trading Partner Agreement Definitions (PDF)

HIPAA Compliant Vendors List (PDF)
A directory of electronic-billing vendors who have successfully tested with us and are in production for the Health Insurance Portability Accountability Act (HIPAA) version of the X12N 837 Health Care Claim.

NPI Information:
Institutional (PDF)
Professional (PDF)
Remittance (PDF)

Secondary Coverage Information:
Health Advantage Billing Requirements for ANSI 837I Secondary Coverage (PDF)
Health Advantage Billing Requirements for ANSI 837P Secondary Coverage (PDF)
Institutional COB Billing Requirements (PDF)
ITS Institutional Secondary Payer Requirements. (PDF)
ITS Professional Secondary Payer Requirements (PDF)
Professional COB Billing Requirements (PDF)

Arkansas Blue Cross and Blue Shield

Electronic Data Interchange (EDI)