HIPAA Testing Checklist

Note: These forms are in portable document format (PDF) and allow you to complete the form online, print, sign, and mail the form to the appropriate address. Download any document in this section by clicking its name.

After the HIPAA transactions and code sets effective date (October 16, 2003), all transmissions of electronic claims to Arkansas Blue Cross and Blue Shield must be in the HIPAA-compliant ANSI X12 837 version 4010A1 format. Prior to migrating to the new format, each provider or the provider's vendor, clearinghouse or billing agent must successfully test the new format with Arkansas Blue Cross EDI Services. The following checklist will help lead you through the process you must follow to become approved for claim submission in the new format.

Select one of the following choices;

Vendor Testing

If you are sending claims directly to Arkansas Blue Cross and are using a software vendor, you should contact that vendor and ask if the vendor is testing its software with Arkansas Blue Cross. If your vendor has no plans to test with Arkansas Blue Cross, you will need to follow the directions in the Individual Testing section. Arkansas Blue Cross 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 completed, the vendor can complete a vendor Blanket Approval form, letting Arkansas Blue Cross know which clients this test will cover. In addition, the following steps must be completed:

  • You must complete a Trading Partner Agreement (TPA) . The completed document must be returned to EDI Services via U.S. Mail to the address noted below.

  • Once EDI Services has processed your TPA and testing is successfully concluded, EDI Services will contact you to establish a date for migrating your submissions to the new format.

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 Transaction User Guide and the Companion Documents (ABCBS Professional and Institutional (PDF) , Medicare Part A (PDF) and Medicare Part B (PDF) ) will be helpful during this process.

  • You must complete a Specialty Testing Form (PDF) . The completed document must be returned to EDI Services via U.S. Mail to the address noted below, or you may fax it to (501) 378-2265.

  • Within three business days, your submitter ID will be added to the Gateway. Gateway Instructions (PDF) will tell you how to access our electronic gateway and upload a file. You also may find the general testing guidelines contained in the X12N Transaction User Guide 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. 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) . This document contains important information about submitting claims in the ANSI format. Consequently, we suggest you complete this document early in the process. The completed document must be returned to EDI Services via U.S. Mail to the address noted below.

  • Once EDI Services has processed your TPA, and testing has successfully concluded, we will contact you to establish a date for migrating your submissions to the new format.

Clearinghouse Testing

If you submit claims through a third party, your clearinghouse or billing agent should test the new formats on your behalf. A list of all of the vendors, including clearinghouses, that have successfully tested with Arkansas Blue Cross is posted on the Medicare websites listed below. If you do not find your clearinghouse's name on this list, we suggest you contact it and inquire about 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.

  • If you are changing from submitting to EDI Services directly to submitting through a clearinghouse or if you are changing from one clearinghouse to another, you must submit a Letter of Authorization (LOA) form to allow Arkansas Blue Cross to accept claims from a third party. Failure to complete the required authorizations may result in rejection of your claims.

  • Blanket Approval will be given to clearinghouses for all of their clients once they have successfully tested and completed the Blanket Approval form. This form lists all providers/submitters for whom the clearinghouse or billing agent will transmit.

  • The clearinghouse must also complete a TPA before migrating submissions to the new format.

Medicare Software Testing

If you will be keying Medicare claims using the MCE Medicare software, the following steps must be completed:

If you already have an EDI submitter number...

  • You may use this number for submission of the new format. You must complete a Trading Partner Agreement (TPA) . The completed document must be returned to EDI Services via U.S. Mail to the address noted below.

  • Once EDI Services has processed your TPA, we will contact you to establish a date for migrating your submissions to the new format.

  • After the migration date is established, your submitter ID will be added to the Gateway. Gateway Instructions (PDF) explains how to access our electronic gateway and upload a file.

  • You must install the MCE software on your computer system. These software and installation instructions may be obtained by calling EDI Services at (866) 582-3247. Should you need help in installing the software, you may call the same number.

  • After transmitting your 4010A1 claim file, reports (ANSI 997, Batch Processing Report and/or ANSI TA1) will normally be returned to your Gateway Electronic Mailbox within 30 minutes.

If you do not already have an EDI submitter number...

  • You must first complete a Trading Partner Agreement (TPA) . The completed document must be returned to EDI Services via U.S. Mail to the address noted below, and a submitter ID will be issued to you.

  • Once you have received your submitter ID, you must complete a Specialty Testing Form (PDF) . The completed document must be returned to EDI Services via fax to (501) 378-2265.

  • Within three business days, your submitter ID will be added to the Gateway. Gateway Instructions (PDF) explains how to access our electronic gateway and upload a file. You may also find the general testing guidelines contained in the X12N Transaction User Guide helpful as well.

  • You must install the MCE software on your computer system. These software and installation instructions may be obtained by calling EDI Services at (866) 582-3247. Should you need help installing the software, you may call the same number.

  • Key in at least 10, but no more than 20, claims relevant to your practice (use real patient data and claim information) to use as your test file.

  • You must transmit a test file to the Gateway System, which 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. EDI Services will contact you via telephone a few days after transmission to discuss your test.

  • Once EDI Services has processed your TPA, and testing has successfully concluded, we will contact you, to establish a date for migrating your submissions to the new format.

Mailing Address

Arkansas Blue Cross and Blue Shield
Attn: EDI Services
P.O. Box 2181
Little Rock, Arkansas 72203-2181


Medicare Websites

Arkansas — www.arkmedicare.com

Louisiana — www.lamedicare.com

Missouri — www.momedicare.com

Oklahoma/New Mexico — www.oknmmedicare.com

Rhode Island — www.rimedicare.com