Register for electronic claims filing
You can register to file claims electronically if your office has a software product that can create the X12 837 electronic format (005010X222, 005010X223, or 005010X224). Many providers who don't have this capability use a clearinghouse or billing agency for this purpose.
How to register to send electronic claims:
- Open and print the Trading Partner Agreement and Trading Partner Registration Form. You must also choose a method of connectivity (SFTP or HTTPS) by completing the Data Transfer Worksheet. For a list of available instruction documents and companion guides, please see HIPAA Transactions Documents below.
- Complete the Trading Partner Agreement and Trading Partner Registration Form and mail them to:
Blue Cross & Blue Shield of Rhode Island
Attn: Manager, EDI & Electronic Information Exchange
500 Exchange Street
Providence, RI 02903
We then will contact you to begin your setup.
HIPAA electronic transactions documents
- 270-271 Companion Guide
- 270-271 How To Conduct Partner Testing
- 276-277 Companion Guide
- 276-277 How To Conduct Partner Testing Instructions
- 277CA Health Care Claim Acknowledgement Companion Guide
- 278 HIPAA 5010 Health Care Services Review Request for Review and Response Companion Guide
- 278 How To Conduct Partner Testing
- 820 Companion Guide
- 820 How To Conduct Partner Testing
- 834 Companion Guide
- 834 How To Conduct Partner Testing
- 835 HIPAA 5010 Health Care Claim Payment/Advice Companion Guide
- 837 and 835 How To Conduct Partner Testing
- 837 HIPAA 5010 Health Care Claim: Dental Companion Guide
- 837 HIPAA 5010 Health Care Claim: Institutional Companion Guide
- 837 HIPAA 5010 Health Care Claim: Professional Companion Guide
- BCBSRI 27x Real-Time API
- BCBSRI Blue Gateway - HTTPS Connection & Transmission Procedures
- BCBSRI Blue Gateway - SFTP Connection & Transmission Procedures
- Provider Control Report Error Message Code Guide
- Trading Partner Agreement
- Trading Partner Registration Form
- Data Transfer Worksheet
HIPAA Transaction FAQs
Are small provider practices exempt from the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Transactions and Code Sets regulations?
No. Regardless of practice size, all providers transmitting designated transactions electronically are subject to the HIPAA Administrative Simplification requirements. Small practices are exempt from the Administrative Simplification Certificate Act (ASCA) provision that excludes paper claims from Medicare coverage. Small practices will be able to continue to submit paper claims. ASCA defines a small practice or supplier as:
- A provider of services with fewer than 25 full-time equivalent employees or
- A physician, practitioner, facility, or supplier (other than provider of services) with fewer than 10 full-time equivalent employees.
What is the process for obtaining the “production green light" for submitting ANSI X-12 transactions?
BCBSRI has developed a partner testing approach to ensure trading partner transactions are HIPAA compliant and meet BCBSRI business rules. The extensive testing required during the partner testing phase should result in a smooth transition to production. In general, the major components are:
- Complete the Trading Partner Agreement and Trading Partner Registration form.
- Successfully test files using the Foresight Online Validator tool.
- Successfully test files through the Blue Cross end-to-end test environment (Phase 2).
For additional information on HIPAA Partner Testing contact the BCBSRI Service Desk at 1-855-721-4211 or firstname.lastname@example.org. An EDI analyst will work with you during each phase of partner testing.
Where can I get a copy of the BCBSRI Companion Guides for submitting/receiving ANSI X12 transactions?
You can obtain copies of our Companion Guides in the HIPAA Transactions Documents above.
The Institutional and Professional Implementation Guides do not specifically address what format to use when submitting home infusion claims. How will BCBSRI process a home infusion claim submitted as an 837 Institutional claim?
BCBSRI EDI Gateway must accept any ANSI-compliant home infusion claim submitted on either 837I or 837P. However, BCBSRI will reject any 837P home infusion claim during the internal business editing process as “not a contracted service for this form type." A home infusion provider would have to use the 837I format in order to receive payment under the terms of their contract.
I use a valid CPT code for something other than what is defined. There is no available code that accurately IDs the program and reimbursement arrangement BCBSRI has with providers. If I continue to do this, would this be in violation of HIPAA compliance?
In situations where there is no clear national code set equivalent, the closest valid national code set will be selected and used to process applicable claims.
How is an 837 claim that has more than 28 lines handled within BCBSRI?
We accept the HIPAA limits—50 lines for Professional claims and 98 lines for Institutional claims. If a professional claim has more than 50 lines, it is rejected up front and will appear on your Provider Control Report. If we receive an institutional claim with more than 98 lines, the claim is split manually.
Should there always be a 999 Acknowledgement for each 837 file submitted?
You should always expect a 999 Acknowledgement and Plain Language 999 for each 837 file you submit. If a reasonable time has elapsed since file submission and you have yet to receive the appropriate 999, please contact BCBSRI Service Desk at (401) 751-1673 or 1-855-721-4211 for assistance.
Will providers continue to receive the current paper remittance advice (RA)?
Yes, for those providers who are not enrolled in direct deposit, the current paper remittance advice will be produced.
After getting the “go ahead" for submitting ANSI X-12 claims in production, will there be changes I need to make? If so, what are those changes?
Sí. You will need to change the first position of the Submitter ID from "T" (test) to "P" (production). You will also need to change the ISA15 from "T" (test) to "P" (production).
I have “Provider Control Reports" in my mailbox. What is the purpose of these reports?
The Provider Control Reports identify claims that were not accepted for claims adjudication. This reject report will list any claim that is rejected from our front-end edit process and the reason the claim rejected. These claims must be corrected by you and resubmitted for processing.
What is the difference between a Type 1 and Type 2 NPI?
Type 1 NPIs are healthcare providers, such as physicians and dentists. Type 2 NPIs are organizations such as facilities, hospitals, home health agencies, labs, and DME suppliers.
Contact the BCBSRI Service Desk: