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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 USAble Administrators 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 USAble Administrators and are using a software vendor, you should contact that vendor and ask if the vendor has tested its its software with us. Please review our HIPAA Compliant Vendors List (PDF) for a list of all of the vendors and clearinghouses that have successfully tested with USAble Administrators. If your vendor has no plans to test with USAble Administrators, you will need to 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 USAble Administrators know which clients the testing covered. 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 the U.S. Postal Service to the address noted below or via fax to (501) 378-2265.
  • Once EDI Services has processed your TPA 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 Transaction User Guide and the Companion Documents ( USAble Administrators Professional and Institutional (PDF)) 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 (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 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. The EDI Report User Guide (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). 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 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.

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 (PDF) for a list of all of the vendors and clearinghouses that have successfully tested with USAble Administrators 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 USAble Administrators. All organizations that have successfully tested with USAble Administrators 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) form to allow USAble Administrators 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 TPA before migrating submissions to the new format.

If you already have an EDI submitter number...

  • You may use this number for submission of the new format. You must complete a TPA. 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, we will contact you to establish a date for beginning your claims submissions to the Gateway.
  • After the claims submissions 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. 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 (PDF) explains how to access our electronic gateway and upload a file. You will also find the general testing guidelines contained in the X12N Transaction User Guide 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 at least 10 claims Usable Administrators.
  • 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 (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, 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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