Arkansas Blue Cross Blue Shield
Please follow the Enrollment Instructions below to become an electronic submitter for Arkansas Blue Cross Blue Shield.
Required Documents for those applying for new Submitter IDs
The following documents are required enrollment documents that must be completed, signed and returned to the Pinnacle office prior to initiation of electronic claims submission or inquiry.
- Trading Partner Agreement (Providers AND Billing Services using ClaimShuttle)
- Electronic Remittance Advice Request
If the above links do not work properly, please download them from:
If you have any questions regarding any of the documents in this package, please call the Pinnacle EDI Technology Support Center at 501-378-2336
We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.
Providers & Billing Services
Trading Partner Agreement
For Providers & Billing Services who will be submitting directly to AR BCBS
First Document: EDI Trading Partner Agreement
Please complete the top of the first page of this document.
Please complete the Trading Partner line on Section VII with your information.
Fill in your demographic information along with Name and Title
In the Signature Section, fill in your information
New applicants may leave the Submitter # blank
If you would like to receive EOBs electronically, check the box for 835 (new applicants may leave the submitter ID line blank)
In the 837 Claims Transmission Information, choose the 3rd option that states you will be sending directly from your facility using the dial up Gateway.
Complete the Vendor Section with the information for the software or vendor that creates your 837 files you need ClaimShuttle to transfer for you. If you have paid for our SolAce billing software please call our support line for our SolAce software information.
Billing Services must complete the Trading Partner Agreement packet above. Once you have been assigned a Submitter ID, have each of your clients complete a Trading Partner Agreement Form
Trading Partner Agreement form for Providers under your Billing Service
Please have your providers complete this form and authorize your Billing Service Submitter ID to send claims on their behalf under the 837 Claims Transmission Information section.
Electronic Remittance Advice Request
Filling this form out will enable submitters to receive their EOBs electronically in ClaimShuttle. Please submit this form after you have been assigned a submitter ID.
Enter the Submitter ID used for the provider’s electronic billings
Enter the Submitter ID of the Business or Provider that will be receiving the electronic EOBs. If you are using a Billing service and you would like your billing service to receive your EOBs please enter the billing service’s Submitter ID.
Enter the current date as the Effective date
Enter the provider’s Name, PIN, NPI, and demographic information
Indicate whether you will be receiving EOBs for Professional or Institutional claims. Mark both if both apply.
Have the provider sign and date the bottom.
Submitting your Forms
It is recommended that you keep a copy of all the forms you will be submitting for your records. Mail the enrollment forms reflecting original signatures to:
Medicare EDI Services 4-BC/S
P.O. Box 2181
Little Rock, AR 72203-2181
FedEX or UPS:
601 S. Gaines St.
Little Rock AR. 72201
Fax: (501) 378-2265
It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.
Waiting for a Response
Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)
After processing, a confirmation will be sent to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the Technology Support Center toll-free at 501-378-2336
Once you have received your Submitter ID and Password from BCBS, please call the ClaimShuttle Support Team and set an appointment for a Mailbox setup and Test Transmission.
Please have 25 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.