Companion Guide - Arkansas Blue Cross and Blue Shield

Companion Guide
Trading Partner Information
ASC X12 Standards for Electronic Data Interchange
Technical Report Type 3 (TR3) v.5010

Table of Contents
Preface ............................................................................................................................................................ 2
1. Getting Started ................................................................................................................. 3
1.1 Where to Get Information............................................................................................................... 4
1.2 Enrollment.........................................................................................................................................................................................................................................................4
1.2.1 Existing Electronic Submitters ....................................................................................................... 4
1.2.2 New Electronic Submitters............................................................................................................. 4
1.2.2.1 Trading Partner Agreement ........................................................................................................... 4
1.2.2.2 Electronic Remittance Advice (835)............................................................................................... 4
1.2.2.3 Electronic Submitter IDs and Passwords ....................................................................................... 5
2. Connectivity / Communications................................................................................................................... 6
2.1 Communication Methods ............................................................................................................... 6
2.1.1 Asynchronous Communications..................................................................................................... 6
2.1.2 FTP Communications .................................................................................................................... 6
2.1.3 Moveit / Data Mover....................................................................................................................... 6
2.1.4 AHIN.............................................................................................................................................. 7
3. 5010 Transactions...................................................................................................................................... 7
4. Testing Criteria and Requirements............................................................................................................. 8
5. Reports ..................................................................................................................................................... 10
6. Contact Information..........................................................................................................................11
Page 1

Preface
The information in this companion guide is to provide guidance to trading partners who will be exchanging
electronic data with Arkansas Blue Cross Blue Shield and its subsidiaries. This document is intended to clarify
information for submission of specific electronic transactions. This includes information about enrollment,
connectivity, testing and support.
The Companion Guide will provide trading partners supplemental information and further define specific data
content requirements to be used in conjunction with, and not in place of, the ASC X12N TR3s for transactions
mandated by HIPAA for electronic data interchange.
An electronic data interchange trading partner is defined as any customer that transmits or receives electronic
data to or from Arkansas Blue Cross Blue Shield and its subsidiaries. The Arkansas Blue Cross Blue Shield
family of companies includes:
Arkansas Blue Cross Blue Shield www.arkbluecross.com
Blue Advantage Administrators www.blueadvantagearkansas.com
Health Advantage www.healthadvantage-hmo.com
FEP www.fepblue.org
Access Only www.arkbluecross.com
Medipak www.arkbluecross.com
Medipak Advantage www.arkbluecross.com
ITS www.arkbluecross.com
A customer is defined as a provider, billing service, clearinghouse or software vendor. The Arkansas Blue
Cross Blue Shield Companion Guide has been created to assist you in designing and implementing
transactions for version 5010 to meet line of business specific processing standards. This document will be
updated periodically as deemed necessary. Additional information and updates can be found on the Arkansas
Blue Cross Shield website under the 5010 Resource Center. It is highly recommended and encouraged that
you visit the 5010 Resource Center frequently for updates. The 5010 Resource Center can be accessed at
www.arkansasbluecross.com/providers/5010ResourceCenter.aspx.
Page 2

1. Getting Started
1.1 Where to Get Information
Arkansas Blue Cross Blue Shield and its subsidiaries are committed in providing customer service support to
our trading partners. In an effort to assist trading partners with the implementation of version 5010 and their
data exchange needs, several methods of communication are available.
A 5010 Resource Center has been developed and added to the Arkansas Blue Cross Blue Shield website.
The 5010 Resource Center will provide trading partners information about the implementation of version 5010,
timelines and other valuable information. The 5010 Resource Center can be accessed by clicking on the link
below.
www.arkansasbluecross.com/providers/5010ResourceCenter.aspx
The EDI Services help desk is available to assist trading partners with the implementation of version 5010.
EDI Services can be reached Monday through Friday from 7:00 am to 4:30 pm CST at (501) 378-2419. EDI
Services can provide information about version 5010; assist trading partners with enrollment and connectivity.
Another method of communication is the EDI mailbox. Electronic submitters can submit their questions to
edi@arkbluecross.com.
Trading partners can submit their enrollment questions, paperwork, changes to their current enrollment setup
or submitter update information to edi_enrollment@arkbluecross.com. Additional information and enrollment
forms can be found at http://www.arkansasbluecross.com/providers/edi.aspx. If needed, trading partners can
call EDI Services for assistance at (501) 378-2419.
Information pertaining to the implementation of version 5010 will be published in provider newsletters. Provider
newsletters are published quarterly and are available on the Arkansas Blue Cross Blue Shield website at
http://www.arkansasbluecross.com/providers/.
Page 3

1.2 Enrollment
1.2.1 Existing Electronic Submitters
Trading partners who are currently enrolled with EDI Services and have been issued a submitter ID number
and password will not be required to re-enroll to transition to version 5010. Your current electronic submitter ID
number and password will be used to transmit and receive electronic transactions for version 5010.
1.2.2 New Electronic Submitters
1.2.2.1 Trading Partner Agreement
New providers, billing agents, clearinghouses and software vendors who have never exchanged electronic
data with Arkansas Blue Cross Blue Shield must enroll with EDI Services. The ARKANSAS BLUE CROSS
BLUE SHIELD ELECTRONIC DATA INTERCHANGE TRADING PARTNER AGREEMENT form must be
completed. The form can be downloaded from the Arkansas Blue Cross Blue Shield website at
http://www.arkansasbluecross.com/providers/edi.aspx.
Completed forms can be submitted to EDI Services by US mail, FedEx or UPS, faxed or email. Listed below is
additional information for each method of delivery.
Delivery through US mail: Delivery through FedEx or UPS:
EDI Services – 4BC/S EDI Services – 4BC/S
P. O. Box 2181 601 S. Gaines St.
Little Rock, AR 72203-2181 Little Rock, AR 72201
Fax to: (501)378-2265 Email to: edi_enrollment@arkbluecross.com
Attn: EDI Enrollment
If you have questions or need assistance completing the enrollment paperwork, please contact EDI Services at
(501) 378-2419 or email EDI Services at edi_enrollment@arkbluecross.com.
1.2.2.2 Electronic Remittance Advice (835)
If you are enrolling with EDI Services and want to receive electronic remittance advices you must complete the
ABCBS Electronic Remittance Advice Request Form (ERA/835). The ERA form can be downloaded from the
Arkansas Blue Cross Blue Shield website at http://www.arkansasbluecross.com/providers/edi.aspx.
Completed forms can be submitted to EDI Services using the same delivery methods as the Trading Partner
Agreement.
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1.2.2.3 Electronic Submitter IDs and Passwords
An electronic submitter ID number and a initial password will be assigned to you upon completion of
the ARKANSAS BLUE CROSS BLUE SHIELD ELECTRONIC DATA INTERCHANGE TRADING PARTNER
AGREEMENT and / or the ABCBS Electronic Remittance Advice Request Form (ERA/835).
INITIAL PASSWORDS MUST BE CHANGED UPON THE FIRST LOGIN ATTEMPT.
PROVIDERS ARE NOT PERMITTED TO SHARE THEIR PERSONAL EDI SUBMITTER ID NUMBER AND
PASSWORD WITH:
ANY BILLING AGENT
CLEARINGHOUSE / NETWORK SERVICE VENDOR
ANYONE ON THEIR OWN STAFF WHO DOES NOT NEED TO SEE THE DATA FOR COMPLETION
OF A VALID ELECTRONIC CLAIM, TO PROCESS A REMITTANCE ADVICE FOR A CLAIM, TO
VERIFY BENEFICIARY ELIGIBILTY OR TO DETERMINE THE STATUS OF A CLAIM
NO OTHER NON-STAFF INDIVIDUALS
OTHER ENTITIES
A PROVIDER’S EDI SUBMITTER ID NUMBER AND PASSWORD SERVE AS A PROVIDER’S
ELECTRONIC SIGNATURE AND THE PROVIDER WOULD BE LIABLE IF ANY ENTITY WITH WHICH THE
PROVIDER IMPROPERLY SHARED THE SUBMITTER ID NUMBER AND PASSWORD PERFORMED AN
ILLEGAL ACTION WHILE USING THAT SUBMITTER ID NUMBER AND PASSWORD. A PROVIDER’S EDI
SUBMITTER ID NUMBER AND PASSWORD ARE NOT PART OF THE CAPITAL PROPERTY OF THE
PROVIDER’S OPERATION, AND MAY NOT BE GIVEN TO A NEW OWNER OF THE PROVIDER’S
OPERATION. A NEW OWNER MUST OBTAIN THEIR OWN EDI SUBMITTER ID NUMBER AND
PASSWORD.
PROVIDERS THAT CONTACT A CONTRACTOR TO SUBMIT AND/OR RECEIVE TRANSACTIONS
ELECTRONICALLY USING A BILLING AGENT AND/OR CLEARINGHOUSE/NETWORK SERVICE
VENDOR, ARE REQUIRED TO HAVE AN AGREEMENT SIGNED BY THAT THIRD PARTY IN WHICH THE
THIRD PARTY HAS AGREED TO MEET THE SAME MEDICARE SECURITY AND PRIVACY
REQUIREMENTS THAT APPLY TO THE PROVIDER IN REGARD TO VIEWING OR USE OF MEDICARE
BENEFICIARY DATA.
CLEARINGHOUSE AND THIRD PARTY REPRESENTATIVES MUST OBTAIN AND USE THEIR OWN
UNIQUE EDI SUBMITTER ID NUMBER, USER ID, AND PASSWORD FROM MEDICARE CONTRACTORS
TO WHOM THEY WILL SEND OR FROM WHOM THEY WILL RECEIVE EDI TRANSACTIONS.
All requestors must attest and acknowledge the Arkansas Blue Cross Blue Shield security statement:
Requirements prohibit ABCBS data or ABCBS system access to entities or individuals outside
the United States and its Territories.
Providers, Submitters, Payers, Network Service Vendors, or anyone else who conduct ABCBS
billing, access to ABCBS data or systems, cannot do so outside the United States and its
territories unless explicitly authorized in writing by ABCBS or his/her designated
representatives with concurrence from ABCBS personnel security department.
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2. Connectivity / Communications
2.1 Communication Methods
EDI Services has several communication protocols that electronic submitters can utilize to send and receive
electronic transactions. Electronic submitters will need to determine which communication protocol they want
to use. Call EDI Services at (501) 378-2419 if you have questions about the different communication
protocols.
2.1.1 Asynchronous Communications
Electronic submitters can exchange electronic data through the NetX Gateway by using an asynchronous (dialup)
communication. An internal or external modem is required and a telecommunication package such as
Hyperterminal. It is recommended that electronic submitters use Windows XP. Windows XP comes with
Hyperterminal already installed.
Windows Vista and Windows version 7 do not come with a pre-installed telecommunications package.
Hyperterminal or another telecommunication package will need to be purchased and installed on these
versions of Windows. Hyperterminal can be purchased for Windows Vista and Windows version 7 from
http://www.hilgraeve.com/hyperterminal.html. EDI Services will not support the telecommunication installation
on Windows Vista or Windows version 7. EDI Services will support the setup and connectivity of
Hyperterminal only for Windows XP.
2.1.2 FTP Communications
EDI Services can accept electronic transactions via FTP. Electronic submitters can exchange electronic data
via FTP using a command line or a third party program of your choice. EDI Services will provide support for
connectivity. However, EDI Services will not provide support for any third party programs. Electronic
submitters will be solely responsible for the setup and maintenance of their third party programs. Electronic
submitters are not required to use a third party program. Electronic submitters can continue to transmit and
receive electronic transactions via FTP using a command line.
FTP users are required to connect to the NetX Gateway using a dial-up connection prior to exchanging
electronic data. It is recommended that electronic submitters use Windows XP as their operating system and
Hyperterminal as their telecommunication package.
2.1.3 Moveit / Data Mover
The Moveit method is a form of communication to exchange data with EDI Services. It involves an IP SFTP
enabled setup for file sharing using a server based application. This method of communication would be used
by larger provider practices. Electronic submitters create a location for electronic files to be exchanged.
Moveit will search the location for electronic files that need to be transmitted and send reports back to the
location that you have created. Moveit will perform this function two times a day.
Data Mover is a non-based server application method of communication for exchanging data with EDI
Services. Data Mover users will use a browser with an HTTPS or FTPS to exchange electronic data. This
method of communication would be used by smaller provider practices that do not have a server. Data Mover
allows users to send and receive electronic transactions themselves.
Page 6

2.1.4 AHIN
Electronic submitters who prefer enter claims via direct data entry can do so by using AHIN. Additional
information about AHIN can be found at http://www.arkansasbluecross.com/providers/ahin.aspx.
3. 5010 Transactions
Arkansas Blue Cross Blue Shield and its subsidiaries will exchange the following transactions. Trading
Partners must test and pass the most current adopted errata or addenda version(s).
Transaction Type Version Code
270 / 271 Health Care Eligibility Benefit Inquiry and Response 005010X279A1
276 / 277 Health Care Claim Status Request and Response 005010X212
837 Health Care Claim: Professional 005010X222A1
837 Health Care Claim: Institutional 005010X223A2
837 Health Care Claim: Dental(FEP only) 005010X224A2
835 Health Care Claim Payment/Advice 005010X221A1
999 Implementation Acknowledgment for Health Care Insurance 005010X231A1
Trading partners who will be exchanging electronic transactions for version 5010 must purchase their TR3s
from www.wpc-edi.com. Due to copyright laws, Arkansas Blue Cross Blue Shield cannot provide trading
partners with the TR3’s.
In addition to aforementioned transactions, AHIN users will continue to receive the Batch Processing report.
Page 7

4. Testing Criteria and Requirements
Claims that are submitted for testing should be representative of the services that you intend to submit to
Arkansas Blue Cross Blue Shield 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 BE
PROCESSED. AN EDI ANALYST WILL CONTACT YOU ABOUT YOUR REJECTED FILE.
All claim submitters must produce accurate electronic test claims before being allowed to submit claim
transactions in production. All submitters must send a test file containing at least 25 claims, which are
representative of their practice or services. The number of claims could be increased or decreased, on a case
by case basis, to ensure adequate testing of any given submitter. Test claims are subject to standard syntax
and IG semantic data edits; documentation will be provided when this process detects errors.
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 Blue Shield, the vendor/submitter will make the
necessary correction(s) prior to submitting a production file.
Test results will be provided to the submitter within three (3) business days; during HIPAA
version transitions this time period may be extended, not to exceed ten (10) business days.
Many claim submitters use the same software, or the same clearinghouse to submit their electronic claims to
Arkansas Blue Cross Blue Shield. Arkansas Blue Cross Blue Shield will not require clearinghouses, billing
agents, or software vendors to submit 5010 test files for all of your clients.
Billing services and clearinghouses are not permitted to begin to submit or receive EDI transactions on behalf
of a provider prior to submission of written authorization by the provider that the billing agent or clearinghouse
has been authorized to handle those transactions on the provider’s behalf.
Page 8

5. Reports
Electronic submitters who will be exchanging electronic data in a 5010 format will receive the following reports.
TA1
999
Batch Processing Report
Below is an example of a TA1 report:
ISA*00* *00* *ZZ*00520 *ZZ*E9999 *110407*2007*{*00501*724560196*0*P*:~
TA1*000000004*110406*1324*A*000~
IEA*0*724560196~
Below is an example of a 999:
ISA*00* *00* *ZZ*00520 *ZZ*E9999 *110407*2007*{*00501*724560196*0*P*:~
GS*FA*00520*E9999*20110407*1324000*1*X*005010X231~
ST*999*6PF6FO9PC*005010X231~
AK1*HC*4*005010X222A1~
AK2*837*0001*005010X222A1~
IK5*A~
AK9*A*1*1*1~
SE*6*6PF6FO9PC~
GE*1*1~
IEA*1*724560196~
The Batch Processing report will be created and formatted as it is today with claims submitted in version
4010A1. Electronic submitters will be notified in advance if any changes are made to the Batch Processing
report with the implementation of version 5010.
Page 9

6. Contact Information
If you need assistance or additional information you can contact EDI Services at (501) 378-2419. Other helpful
resources are:
Provider newsletters www.arkansasbluecross.com/providers/
5010 Resource Center www.arkansasbluecross.com/providers/5010ResourceCenter.aspx
EDI Services Enrollment edi_enrollment@arkbluecross.com
EDI email address edi@arkbluecross.com
Washington Publishing Co. www.wpc-edi.com
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