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Electronic Claims Testing
Note: These forms are in portable document format (PDF) and allow you to complete
the form online, print, sign, and mail or fax the form to the appropriate address
or fax number. Download any document in this section by clicking its name. Only
one copy of each document is required per submitter.
Since the HIPAA transactions and code sets effective date (October 16, 2003), all
transmissions of electronic claims to Arkansas Blue Cross and Blue Shield (ABCBS)
are required to be in the HIPAA-compliant ANSI X12 837 version 4010A1 format. Prior
to migrating to the new format or beginning the electronic transmission of claims,
each provider or the provider's vendor, clearinghouse or billing agent must successfully
test the new format with EDI Services. The following information will help lead
you through the process you must follow to become an approved electronic claims
submitter.
Select one of the following choices;
Vendor Testing
If you will be sending claims directly to Arkansas Blue Cross and are using a software
vendor, you should contact that vendor and ask if the vendor has tested its software
with us. Please review our
HIPAA Compliant Vendors List (28 KB PDF)
for a list of all of the vendors and clearinghouses that have successfully tested
with Arkansas Blue Cross. If your vendor has no plans to test with Arkansas Blue
Cross, you must follow the directions in the Individual Testing
section. We will allow vendors to receive "blanket approval" for their software
products. This means the vendor can test on behalf of their customers. Once testing
is successfully concluded, the vendor can complete a vendor Blanket Approval form,
letting Arkansas Blue Cross know which clients the testing covered. In addition,
the following steps must be completed:
- You must complete a
Trading Partner Agreement (TPA) (151 KB PDF)
. The completed document must be returned to EDI Services via the U.S. Postal Service
to the address noted below or via fax to (501) 378-2265.
- Once EDI Services has processed your
TPA (151 KB PDF)
and testing is successfully concluded, you will be contacted to establish a date
for beginning your claims submissions to the Gateway.
Individual Testing
If your vendor will not be testing the new format for you, it will be necessary
for you to submit test transactions for yourself. Several documents, including the
X12N User Guide (622 KB PDF)
, the Companion Documents (ABCBS Professional (222 KB PDF)
and
EDI Institutional Companion Document (202 KB PDF)
) and ABCBS Billing Requirements will
be helpful during this process.
Once your TPA is processed and your submitter ID has been added to Gateway security,
you may log on and submit a test file.
Gateway Instructions (58 KB PDF)
will tell you how to access our electronic gateway and upload a file. You may also
find the general testing guidelines contained in the
X12N User Guide (622 KB PDF)
and ABCBS Billing Requirements helpful.
- You must transmit a 4010A1 test file containing all the specialties for which you
routinely bill.
- Reports (ANSI 997, Batch Processing Report and/or ANSI TA1) will normally be returned
to your Gateway electronic mailbox within 30 minutes. The
EDI Report User Guide (100 KB PDF)
will be helpful in understanding these reports. EDI Services will contact you via
telephone a few days after transmission to discuss your test file.
- You must complete a
Trading Partner Agreement (TPA) (151 KB PDF)
. This document contains important information about submitting claims in the ANSI
format. This document must be received and processed by EDI Services before a submitter
ID will be issued. The completed document must be returned to EDI Services via the
U.S. Postal Service to the address noted below or via fax to (501) 378-2265.
A submitter number will not be issued until the
TPA (151 KB PDF)
is processed by EDI Services.
- Once testing is successfully concluded, EDI Services will contact you to establish
a date for beginning your claims submissions to the Gateway.
- Test data is not processed and must be transmitted again after you have
successfully completed testing and are placed in production mode.
Clearinghouse Testing
If you submit claims through a third party, your clearinghouse or billing agent
should test the new formats on your behalf. Please review our
HIPAA Compliant Vendors List (28 KB PDF)
for a list of all of the vendors and clearinghouses that have successfully tested
with Arkansas Blue Cross and have been given blanket approval. If you do not find
your clearinghouse's name on this list, we suggest you contact your clearinghouse
and inquire about its testing status with Arkansas Blue Cross and have been given
blanket approval. If you do not find your clearinghouse's name on this list, we
suggest you contact your clearinghouse and inquire regarding its testing status
with Arkansas Blue Cross. All organizations that have successfully tested with Arkansas
Blue Cross have been issued a certification letter, which you may want to request
if the clearinghouse's name is not included in the list. Remember, your clearinghouse
or billing agent will always be your first point-of-contact for enrollment and/or
claims questions.
- If you have been submitting to EDI Services directly and will begin submitting through
a clearinghouse, or if you are changing from one clearinghouse to another, you must
submit a
Letter of Authorization (LOA) (14 KB PDF)
form to allow Arkansas Blue Cross to accept claims from a third party on your behalf.
Failure to complete the required authorizations may result in the rejection of your
claims.
- Blanket approval will be given to clearinghouses for all of their clients after
they have successfully tested and completed the Blanket Approval form. This form
lists all providers/submitters for whom the clearinghouse or billing agent transmits
claims.
- The clearinghouse must also complete a
Trading Partner Agreement (TPA) (151 KB PDF)
before migrating submissions to the new format.
If you do not already have an EDI submitter number...
- You must first complete a
Trading Partner Agreement (TPA) (151 KB PDF)
. The completed document must be returned to EDI Services via the U.S. Postal Service
to the address noted below or via fax to (501) 378-2265, and a submitter ID will
be issued to you. If you will be utilizing a clearinghouse, you should contact that
clearinghouse for EDI Enrollment instructions.
- If you are an existing submitter and are ready to test the new format, contact EDI
Services at (501) 378-2419 or toll free at (866) 582-3247 and your existing submitter
ID will be added to Gateway security so you may submit a test file. If you are new
to electronic filing, you may submit a test file to the Gateway once you receive
your submitter ID.
Gateway Instructions (58 KB PDF)
explains how to access our electronic gateway and upload a file. You will also find
the general testing guidelines contained in the
X12N User Guide (622 KB PDF)
and ABCBS Billing Requirements helpful.
- Submit claims relevant to your practice (use real patient data and claim information)
to use as your test file. For a thorough test, please submit 10 claims each for
Arkansas Blue Cross, Health Advantage, First Source, BlueAdvantage, Federal Employees
Program (FEP) and BlueCard®.
- You must transmit a test file to the Gateway system that contains all of the specialties
for which you routinely bill.
- Reports (ANSI 997, Batch Processing Report and/or ANSI TA1) will normally be returned
to your Gateway electronic mailbox within 30 minutes. The
EDI Report User Guide (100 KB PDF)
will be most helpful in understanding these reports. EDI Services will contact you
via telephone a few days after transmission to discuss your test file.
- Once EDI Services has processed your
TPA (151 KB PDF)
, and testing has successfully concluded, we will contact you to establish a date
for beginning your claims submissions to the Gateway.
EDI Services Fax:
(501) 378-2265
Mailing Address:
EDI Services
P.O. Box 2181
Little Rock, Arkansas 72203-2181
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