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.

If the above links do not work properly, please download them from:
http://www.arkbluecross.com/providers/edi.aspx

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
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.

Section 1

  • 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

 

Testing

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.