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HIPAA 5010 276/277 Conpanian Guide

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1. iG WEINDOUSN systcn32oftp Ftp open 192 168 103 135 2021 Connected to 192 168 163 135 228 AZBAtcAiZ FRE_FIP CVYcrsion Fri Jul 25 11541518 EDT gt server ready User 192 168 183 135 lt nonc gt gt 1GV BB SCA 331 Passvord required for 1GWYBBBBSCB Passuord 238 User LGYBBBBSCB logged in Ftp gt Figure 20 MS DOS Prompt Window with FTP Connection d Type your user name at the User prompt and press ENTER e Type your password and press ENTER 4 6 1 Uploading Files Using FTP 1 To upload a file after connecting a At the ftp gt prompt type bin and press ENTER ftp gt bin 200 Type set to I b At the ftp gt prompt type cd inbound and press ENTER ftp gt cd inbound 250 CWD command successful c Type Is and press ENTER ftp gt Is 200 PORT command successful 150 opening data connection for d Type Iced d and the path name to the file on your local directory Press ENTER Note The file name you wish to retrieve must exactly match the file name on your local directory Your local directory drive may be different from the example above ftp gt icd d the path name to the file on your local directory e Type put your file name and CUSTOMER_UPLDI FTP Then press ENTER ftp gt put YOURFILENAME CUSTOMER_UPLD FTP Note Your file name can be no more than 30 characters in length f After the file has been successfully uploaded you will receive a Transmission Successful message DECE
2. K1200055 X1200057 X1200058 12 T0310034677000 12 T0310034677000 12 10317034677000 12 T0317034677000 End of file list press any key to continue Connected 0 01 25 vT100 sa4008 N 1 SCROLL CAPS NUM Capture Print echo Figure 11 Mailbox File List If the file transfer is complete and successful the Transfer COMPLETED SUCCESSFULLY message will appear on the screen and the file will be deleted from the mailbox If the file transfer fails the Transfer FAILED message will display Files that have not been downloaded successfully will remain in the mailbox for 14 days before being purged DECEMBER 2012 18 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 4 List Files in Mailbox for X12 Transactions To check on files that you may have available to download from GPNet 1 Choose List Files in Mailbox by pressing 3 or L from the Main Menu and press ENTER 2 The system will prompt you to enter the name of the file you wish to see You can type the full or a partial file name combined with an optional wildcard All files matching the search pattern will be displayed You can also leave the file name field blank and just press ENTER to see a list of all the files in your mailbox Note This same list also displays when you select the Xmodem Protocol from the Download option If no matching files are found the system will display this message No files match your speci
3. Transaction Rules the submission and payment of claims for medical services and supplies rendered or sold to Covered Individuals NOW THEREFORE in consideration for the mutual promises herein the Parties agree as follows DEFINITIONS The following terms with initial capitals have these meanings 1 1 ANSI means American National Standards Institute an organization whose Accredited Standards Committee develops and approves uniform standards for the electronic interchange of business transactions 1 2 Business Associate means a third party organization designated in the Trading Partner Business Associate Authorization Rider that contracts with Trading Partner to perform services to facilitate the electronic transfer of Data or funds or to conduct other business functions on behalf of Trading Partner Examples of Business Associates include without limitation clearinghouses vendors billing services service bureaus accounts receivable management firms and banking institutions 1 3 Confidential Health Information means information relating to specific Individuals including Individually Identifiable Health Information and Health Information that is exchanged by and between BlueCross BlueShield of South Carolina and Trading Partner or Business Associate for various business purposes and that is protected from disclosure to unauthorized persons or entities by Social Security Act 1171 et seq the Standards for Privacy of Indivi
4. The file would contain a text message that describes the error shown in the Response Example here Sample Set 3 If the file received has X12 TR3 edit errors two files will be returned to the trading partner containing the ASC X12 TA1 and 999 respectively Sample Set 4 This is a file name when the file s content is an informational message Sample Set 5 If the file returned to the trading partner is an ASC X12 835 transaction the file description field will have the payer s name Example BlueCross BlueShield of South Carolina for BlueCross BlueShield of South Carolina commercial remittance advice files DECEMBER 2012 20 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 5 Password Change Procedures Note Dial up FTP does not accommodate password change commands In order to change passwords the trading partner should follow the password change procedures instructions in this section of the manual or get software that allows command line site function to change your password 1 Enter 6 or P from the Main Menu REDI EDIGATEWAY TEST Hyper Terriinal Dae 5 3 Ole ce Welcome ist Files in Mailbox i assword Mgmt Selection 2 Once you re in the password change procedure select ENTER at any prompt without entering any data to exit the password management option 3 You ll receive a message similar to you did not enter anything for and Press ENTER to
5. Content Disposition form data name CORERuleVersion 2 2 0 XbCY DECEMBER 2012 43 BlueCross BlueShield of South Carolina 276 277 Companion Guide Here is an example of a Batch Submission Acknowledgement Retrieval Response message using the HTTP MIME Multipart envelope method HTTP 1 1 200 OK Content Length 12648 Content Type multipart form data boundary XbCY XbCY Content Disposition form data name PayloadT ype X12_999 Response_005010X231A18 XbCY Content Disposition form data name ProcessingMode Batch XbCY Content Disposition form data name Payload D 81d4fae 7dec 11d0 a765 00a0c91 e6da 6 XbCY Content Disposition form data name PayloadLength 10240 XbCY Content Disposition form data name TimeStamp 2007 08 30T 10 20 34Z XbCY Content Disposition form data name Sender D PayerB XbCY Content Disposition form data name Receiver D HospitalA XbCY Content Disposition form data name CORERuleVersion 2 2 0 XbCY Content Disposition form data name Checksum 6A3FE55946 XbCY Content Disposition form data name Payload lt contents of batch file go here gt XbCY Content Disposition form data name ErrorCode Success XbCY Content Disposition form data name ErrorMessage None XbCY DECEMBER 2012 44 BlueCross BlueShield of South Carolina 276 277 Companion Guide Here is an example
6. SOAP compliant to standards set forth by Web Services Description Language WSDL for XML formatting submission and retrieval 4 15 1 SOAP XML Schema The XML schema definition set forth by CORE and used by BlueCross BlueShield of South Carolina is located at www cagh org CORE_phase2 php File name XML Schema Specification normative This file contains definitions for each type of request or response accepted or sent by BlueCross BlueShield of South Carolina 4 15 2 WSDL Information The WSDL definition set forth by CORE and used by BlueCross BlueShield of South Carolina is located at www caqh org CORE_phase2 php File name XML Schema Specification normative This file conforms to the XML schema and contains definitions for each message and transaction type accepted by BlueCross BlueShield of South Carolina 4 15 3 SOAP Fault Formatting There are two versions of the SOAP specification 1 1 and 1 2 Each version defines SOAP Faults in a slightly different manner All BlueCross BlueShield of South Carolina applications will generate only version 1 1 SOAP Faults BlueCross BlueShield of South Carolina will accept both version 1 1 and version 1 2 SOAP Faults from partner provided services BlueCross BlueShield of South Carolina applications populate SOAP faults with information in a specific format which is designed to make possible programmatic identification of error conditions The SOAP fault elements emitted are defined as follow
7. South Carolina Each party consents and submits to the jurisdiction of such court and agrees that venue therein shall be proper and convenient In any such action or proceeding in such court each party waives any right to raise any objection based upon improper venue lack of jurisdiction or inconvenient forum and each party consents to personal jurisdiction of such court and agrees service of process may be effected by United States mail EACH PARTY WAIVES ANY RIGHT IT MAY HAVE TO A TRIAL BY JURY IN ANY LITIGATION ARISING OUT OF UNDER OR IN CONNECTION WITH THIS AGREEMENT 9 5 Assignment of Rights and Delegation of Duties This Agreement is binding upon and inures to the benefit of the Parties and their respective successors and assigns BlueCross BlueShield of South Carolina retains the right to assign or delegate any of its rights or obligations hereunder to any of its subsidiaries affiliates or successor companies Otherwise neither Party may assign its rights or delegate its obligations under this Agreement without the prior written consent of the other Party which consent will not be unreasonably withheld or delayed 9 6 Relationship of BlueCross BlueShield of South Carolina to the Blue Cross and Blue Shield Association This Agreement constitutes a contract between Trading Partner and BlueCross BlueShield of South Carolina BlueCross BlueShield of South Carolina is an independent corporation operating under a license with the Blue Cross and B
8. South Carolina immediately upon Trading Partner s receipt of any request from a government authority for information or documents relating to this Agreement except to the extent such notification is prohibited by law Vil REPRESENTATIONS AND WARRANTIES 7 1 Government Programs Trading Partner represents and warrants that a Neither the United States government any state or local government nor any prime contractor subcontractor or other person has notified Trading Partner either orally or in writing that Trading Partner has breached or violated any law certification representation clause provision or requirement pertaining to or involving any government contract or government subcontract that has resulted or may result in Trading Partner being charged with a criminal offense b No termination for convenience termination for default cure notice or show cause notice is currently in effect or threatened against Trading Partner by the United States government or any state or local government c Neither Trading Partner nor any of its directors officers employees or agents are or have been under criminal investigation or indictment by any government entity d Trading Partner has not been debarred or suspended from participation in the award of contracts with any government entity excluding for this purpose ineligibility to bid on certain contracts due to generally applicable bidding requirements e There exists no fact o
9. X12_005010_ Request_BatchResultsMixed e Mixed Batch Pickup X12_TA1_SubmissionRequest_00501X231A1 e TA1 Pickup Batch X12_999 RetrievalRequest_005010X231A1 e 999 Pickup Batch e Payload ID o Should conform to ISO UUID standards described at www rfc editor org rfcxx00 html with hexadecimal notation generated using a combination of local timestamp in milliseconds as well as the hardware MAC address35 to ensure uniqueness e Sender ID 50 character max e CORE Rule Version o Accepted value is 2 2 0 e Receiver ID 50 character max Payload o This contains the X12 request e Payload Length o Length of the X12 document required only if Processing Mode is Batch e CheckSum o Checksum of the X12 document using SHA 1 encoding is hex required only if Processing Mode is Batch e TimeStamp o Inthe form of YYYY MM DDTHH MM SSZ see www w3 org TR xmlschema11 2 dateTime DECEMBER 2012 37 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 14 2 Error Reporting There are three levels of error validation involved in a BlueCross BlueShield of South Carolina MIME multipart transaction e HTTP Errors with connectivity authorization etc will be reported at this level o HTTP 200 OK success o HTTP 202 Accepted batch submission accepted not necessarily processed o HTTP 400 Bad Request error with formatted HTTP headers o HTTP 500 Internal Server Error error during processing e Envelope Errors rega
10. contractor subcontractor or other person has notified Trading Partner either orally or in writing that Trading Partner has breached or violated any law certification representation clause provision or requirement pertaining to or involving any government contract or government subcontract that has resulted or may result in Trading Partner being charged with a criminal offense b No termination for convenience termination for default cure notice or show cause notice is currently in effect or threatened against Trading Partner by the United States government or any state or local government c Neither Trading Partner nor any of its directors officers employees or agents are or have been under criminal investigation or indictment by any government entity d Trading Partner has not been debarred or suspended from participation in the award of contracts with any government entity excluding for this purpose ineligibility to bid on certain contracts due to generally applicable bidding requirements e There exists no fact or circumstance that would warrant the institution of suspension or debarment proceedings or the finding of non responsibility or ineligibility on the part of Trading Partner or any director officer or employee of Trading Partner and f No payment has been made by Trading Partner or by any person on behalf of Trading Partner in connection with any government contract or government subcontract in violation of or requir
11. thimm ss CUMBIA SC 29219 PROCESS DATE TRASSACTION TYFE SESCRIEEFR F SRNIE AE REJ OD MER D mM D TORL CARES AC TET XHOCOCCOOOOSCOGOOOSOOX GOSGOSOOGCOOK K DOGDOOCOOOCOSCOGOOOOOX JOOGSCOGSGOOX X mm dd yy mm dd yy Sion 200K xr x x ERR SANT LOOP REPEAT S FIELD REPEAT RRR TYE ROSIN XX x xX XX x DS DS DG OS OS OOS OS OOS Da he DECEMBER 2012 33 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 11 2 Error Claim Summary Report Batch TA1 999 Process Flow Here is an example a batch TA1 999 acknowledgment pickup request CORE Compatible Application Send request to A HTTP 401 x Authorization Invaild TTP 40 A N Vaild te BS Associated with a Provider x lt Payload ID Exists ih YW lt HTTP 200 and TA1 999 Reject o 999 Acceptance Same day x DECEMBER 2012 34 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 11 3 Error Claim Summary Report 271 Batch Pickup Process Flow Here is an example of a 271 batch pickup request CORE Compatible Application Send request to A x Authorization nvaild HTTP 401 Vaild Associated with a Provider X s N0 M W o 7 lt lt LD V Payload ID Exists M Fi HTTP 200 and 271 Response s DECEMBER 2012 35 BlueCross BlueShield of South Carolina 276 277 Companion Gui
12. 07 HyperTerminal Windows 95 98 and NT The settings you should verify are e Terminal emulation VT100 e Parity NONE e Data Bits 8 e Stop Bits 1 For Zmodem ensure that both sender and receiver crash recovery is OFF or set to OVERWRITE When downloading a file this setting will determine whether Zmodem overwrites an existing file of the same name Since the response file name will be repeated we recommend that the downloaded files be renamed or moved to another directory immediately to avoid losing or overwriting a file In addition we encourage the use of PKZIP compatible compression software GPNet defaults to send uncompressed files Therefore if you wish to receive your files in a compressed format please indicate this on your enrollment form or contact the Technology Support Center The GPNet asynchronous transmission is a dial up connection Depending on your operating system your windows may display differently than those noted in these figures DECEMBER 2012 11 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 1 Dial up REDI Initial Set Up Using Asynchronous Dial up To submit files using the GPNet asynchronous dial up first you must make a connection and log in 1 Click on Start then Programs then Accessories and then click on the HyperTerminal option This will open the Connection Description window Type a name and choose an icon for the connection Then cl
13. A provides practice management systems to Provider A The system has the capability to build SOAP based ANSI transactions for submission to various payers or clearinghouses Provider A expresses an interest in being able to process real time ANSI data so Software Vendor A instructs the provider on how to set up this feature Provider A can then use their credentials they use for the BlueCross BlueShield of South Carolina Blue Access system to send these transactions Provider A wishes to send real time transactions but does not have a clearinghouse relationship or practice management system that supports this feature They therefore use in house or contract talent to develop a customized HTTP MIME multipart submission page that they can then use in conjunction with their Blue Access credentials to submit Blue transactions DECEMBER 2012 74 BlueCross BlueShield of South Carolina 276 277 Companion Guide C1 Frequently Asked Questions What forms do I need to complete to be able to send HIPAA transactions You must complete the Trading Partner Agreement and the EDIG Enrollment Form If you represent a hospital or are a doctor or other health care professional who will be transmitting transactions directly to us you should complete Appendix F If you are a clearinghouse complete Appendix E use a clearinghouse to process my transactions So do not need to do anything right Clearinghouses must complete and sign Appendix E If you pl
14. BlueChoice HealthPlan of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association DECEMBER 2012 57 BlueCross BlueShield of South Carolina 276 277 Companion Guide 6 2 X12 Outbound Transactions This table lists envelope contents for outbound from EDI Gateway HIPAA X12 transactions Segment Data Element Description Identifier ISA01 Authorization Info Qualifier 00 ISA02 Authorization Information Blanks ISA03 Security Information Qualifier 00 ISA04 Security Information Blanks ISA05 Interchange ID Qualifier 30 qualifier indicating U S Federal Tax Identification Number ISA06 Interchange Sender ID Sending entity s U S Federal Tax Identification Number ISA07 Interchange ID Qualifier If 271 277 or 278 transaction ISA07 will be the same value of the associated inbound 270 276 or 278 ISAO5 If 999 TA1 or EDIG claim response ISA07 will be the same value of the associated inbound transaction s ISA05 Otherwise value is ZZ ISA08 Interchange Receiver ID If 271 277 or 278 transaction ISA08 will be the same value of the associated inbound 270 276 or 278 ISAO6 If 999 TA1 or EDIG claim response ISA08 will be the same value of the associated inbound transaction s ISAO6 If above ISA07 is ZZ value is EDIG assigned Trading Partner ID ISA09 Interchange Date Populated by EDIG ISA10 Interchange Time Populated by EDIG ISA
15. DECEMBER 2012 26 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 6 Dial up FTP The GPNet communication interface also allows an FTP connection This is a direct dial up connection All files must be transmitted in binary format ASCII will not be processed The default setting is ASCII so you must issue the Bin command to change the format to binary You can confirm the change by issuing the Status command and verifying the change was accepted Depending on your operating system your windows may display differently than those noted in these figures Logging onto GPNet Using FTP ae TE To submit files using the GPNet FTP ay Comper Al seal al first you must make a connection and Ss a 8 2 2 8g B log in 4 Flopey ts C 0 1 Create a Windows Dial Up Sys on Kbrannon on Edirai 1 on Apps on A7Onnds1 F A7Onbebs3 A7Onbebs3 A70nbebs3 Networking session Open a My fsa Za SSS RRS SRI win SBS Computer window and double click Inbebs3 A7Onbebs3 Inbeb mo nbcb ris A7Onbebs3 the Dial Up Networking folder 2 2 M R Sys on Sys on Control Panel Printers Scheduled Web Folders Figu re 1 2 7 A70nnds1 A7 nbcb Tasks Figure 12 My Computer Window 2 Open Make New Connection Fa Dial Up Networking MEE File Edit View Connections Help Figure 13 E Dapena A a Ol Beale 9 xo Ses Figure 13 Dia
16. Force Majeure Each Party will be excused from performance for any period of time during this Agreement that it is prevented from performing any obligation or service in whole or in part as a result of causes beyond its reasonable control and without its fault or negligence Such acts include without limitation acts of God strikes lockouts riots acts of war epidemics governmental regulations imposed after the fact fire communication line failures power failures earthquakes floods or other natural disasters Delays in performance because of the occurrence of such events will automatically extend due dates for a period equal to the duration of such events Such automatic extension will have no effect on the exercise of either Party s right of voluntary termination of this Agreement under Section 2 2 of this Agreement 9 8 No Waiver Failure or delay on the part of either Party to exercise any right power privilege or remedy in this Agreement will not constitute a waiver No provision of this Agreement may be waived by either Party except in a writing signed by an authorized representative of the Party making the waiver 9 9 No Agency Nothing in this Agreement will place BlueCross BlueShield of South Carolina and Trading Partner in a relationship whereby either i is the principal or agent of the other for any purpose or ii has the authority to bind the other in any way 9 10 Severability The provisions of this Agreement are severab
17. HyperTerminal Torx File Edit View Call Transfer Help 1GWOOOOSCO logged in at 2003 04 16 15 15 30 last login 2003 03 17 15 53 39 KEK KERR BULLETIN gt gt gt gt gt gt gt gt gt gt gt gt gt gt gt gt gt gt gt gt gt gt gt gt gt gt Press lt RETURN gt to continue gt Connected 0 00 46 Auto detect 38400 8 N 1 SCROLL CAPS NUM Capture Print echo Figure 6 GPNet Message Screen This screen features two distinct parts e User login information displays information about current and previous login activity e The system wide banner displays important information for all trading partners After reading any banner messages press ENTER to continue to the Main Menu DECEMBER 2012 15 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 3 2 Main Menu From the Main Menu Figure 7 you can either choose the number or the first letter of the action you want Press ENTER REDI EDIGATEWAY TEST Hyper Terminal Welcome ist Files in Mailbox uit assword Mgmt Selection DECEMBER 2012 16 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 3 3 Upload a File To upload a file to GPNet 1 Type 2 or U from the Main Menu and then press ENTER 2 You will be prompted to select the file transfer protocol Figure 8 Do not press ENTER after making your selection Type the letter corresponding to your choice of modem protocol If you select
18. Martha Owens Perry Title AVP Health Care Services To Trading Partner Address City State ZIP Code Attn Title 9 2 Amendments This Agreement may not be changed or modified except by an instrument in writing signed by each Party s authorized representative 9 3 Choice of Law This Agreement and the Parties rights and obligations hereunder are governed by and will be construed under the laws of the State of South Carolina 9 4 Jurisdiction Venue and WAIVER OF JURY TRIAL The Parties agree that any action or proceeding arising out of or related to this Agreement shall be instituted only in the Federal District Court in Columbia South Carolina Each party consents and submits to the jurisdiction of such court and agrees that venue therein shall be proper and convenient In any such action or proceeding in such court each party waives any right to raise any objection based upon improper venue lack of jurisdiction or inconvenient forum and each party consents to personal jurisdiction of such court and agrees service of process may be effected by United States mail EACH PARTY WAIVES ANY RIGHT IT MAY HAVE TO A TRIAL BY JURY IN ANY LITIGATION ARISING OUT OF UNDER OR IN CONNECTION WITH THIS AGREEMENT 9 5 Assignment of Rights and Delegation of Duties This Agreement is binding upon and inures to the benefit of the Parties and their respective successors and assigns BlueCross BlueShield of South Carolina retains the right to assi
19. New Trading Partner ID Check One 7 Change Cancel Trading Partner s Name Trading Partner s ID Federal Tax ID Type of Business Institutional Health Care Provider Clearinghouse Billing Service Check One Professional Health Care Provider Health Care Plan Retail Pharmacy Pharmacy Benefit Manager Software Vendor 7 Other indicate Line of Business BlueCross BlueShield of South Carolina Commercial Check One PGBA LLC Start Date ___ Es Mmidd ccyy End Date ___ mm dd yy Required when canceling an account Compression gQ No Compression O PKZIP a UNIX Check One Protocol wom FTP DIALUP ASYNC DIALUP product Check One M Secure FTP TIVPN tTcpiP viaveN TCPIP via AGNS Service Address Address 1 Address 2 City State ZIP Billing Address If different from the Service Address Address 1 Address 2 City State ZIP Primary Contact s Information FirstLast Name _ _ gt o Emaik Telephone oe ext CE fax eee Primary Technical Contact s In T FirstLast Name __ Z 7 Emaikl Telephone EE ext lee Fax _o After Hours Technical Contact s Information First Last Name ssssssssSsS C C E mand Telephone _ et o Fax j On Call Technical Contact s Information First Last Name Email Telephone _ et_ Fax DECEMBER 2012 79 BlueCross BlueShield of South Carolina 276 277 Companion Guide Transaction Volume
20. Partner access under this Agreement In the event that Trading Partner receives data or Data Transmissions not intended for Trading Partner Trading Partner will immediately notify BlueCross BlueShield of South Carolina and make arrangements to retransmit or otherwise return the data or Data Transmission to BlueCross BlueShield of South Carolina After such retransmission or return Trading Partner will immediately delete the data and Data Transmission from its Operating System c Protect and maintain the confidentiality of Security Access Codes issued to Trading Partner by BlueCross BlueShield of South Carolina and limit disclosure of Security Access Codes to authorized personnel on a need to know basis d Provide BlueCross BlueShield of South Carolina in writing all information requested in Exhibit A to this Agreement not later than Trading Partner s execution of this Agreement While this Agreement is in effect Trading Partner will notify BlueCross BlueShield of South Carolina in writing within one 1 business day of any material change in the information on Exhibit A to this Agreement 3 3 Obligations BlueCross BlueShield of South Carolina will a Make available to Trading Partner via electronic means data and Data Transmissions for which this Agreement grants Trading Partner access or authorization or as provided by law b Provide Trading Partner with at least sixty 60 days prior written notice of any change or addition to
21. Q you will return to the Main Menu gt gt gt gt UPLOAD A FILE lt lt lt lt xxx Select Protocol K for Kermit X for XMODEM Y for YHODEH BATCH Z for ZHODEH or Q to QUIT Figure 8 Upload Protocol Selection Screen 3 Using your communication software procedures send the file you wish to upload 4 If the file transfer is successful Transfer COMPLETED SUCCESSFULLY will display on the screen Figure 9 If the file transfer fails the message Transfer FAILED will display e Please place your pe in ZMODEM mode to send the file 60000900272214 50000400272214 B0DOD0D4DODZ7ZZ1LA 50000400272214 B0000400272214 4 Transfer COMPLETED SUCCESSFULLY t Press lt Return gt to continue Figure 9 Successful Transfer Message 5 Press ENTER to return to the Main Menu 6 Upon successful transmission of a file you can exit the system or wait for a response file a To exit the system press 5 or Q from the Main Menu and then press ENTER You can dial in a few minutes later to download the TA1 and IG edit results b To stay on the system and check for a response file press 3 or L to go to the Mailbox and wait for the response file to load The time between a file upload and the response file availability will vary based on the file size and user volume Although most responses are available within one hour please allow 24 hours before contacting the Technology Support Cent
22. With Comments http www ws org TR 2001 REC xml c14n 20010315 WithComments All algorithms required by the WS I Basic Security Profile v1 0 are supported but our preferred algorithms are Block Cipher AES 256 http www w3 orgq 2001 04 xmlenc aes256 cbc Digest SHA 256 http www w3 org 2001 04 xmlenc sha256 5 Requests and or responses may be encrypted if the data contained within the request or response is sufficiently sensitive If encryption is employed the encrypted element must be a child of either the SOAP header or the SOAP body elements 6 Responses may be digitally signed by BlueCross BlueShield of South Carolina if the partner desires DECEMBER 2012 10 BlueCross BlueShield of South Carolina 276 277 Companion Guide The GPNet communication interface supports asynchronous telecommunications up to 56K bps It will support numerous asynchronous telecommunication protocols including Kermit Xmodem Check Sum Ymodem Batch and Zmodem Most off the shelf communication software will support one or all of these protocols You can select any of the protocols listed here We recommend Zmodem however based on its speed and reliability The asynchronous user s modem should be compatible with 56K V 34 28 8 bps and V 42 14 4 bps e ProComm Plus Release 2 11 Windows Crosstalk Release 2 2 Windows QuickLink2 Release 1 4 3 Windows PC Anywhere Release 2 0 Windows Term Release 6 1 6 2 and 6 3 Mlink Release 6
23. ZIP ISACTRLOOO1 Note The file name you wish to retrieve must exactly match the file name in the outbound directory wild cards will be accepted only if glob is on e When the download is complete you will get a Transfer Complete message f To delete files from the outbound mailbox issue a del command at the ftp gt prompt ftp gt del X1200001 ZIP ISGACTRLOOO1 Note If you do not delete the files after successfully downloading them they will remain in the outbound directory for 14 days at which time they will be automatically purged If you have multiple files to retrieve you can use the mget command which will prompt you to confirm each file prior to the initiation of each file transfer unless you have prompt turned off DECEMBER 2012 30 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 7 Secure File Transfer Protocol SFTP Trading partners choosing this option will connect through a firewall to a Windows NT server on the BlueCross BlueShield of South Carolina network You can access this server via the Internet Additional authentication is done through the use of a unique login ID and public key file When this authentication is complete the trading partner will upload files into the inbound directory where they will be uploaded for EDI Gateway processing Trading partners should query the outbound directories to retrieve acknowledgment and response files When you choose this connectivity
24. and must be populated with the subscriber s ID number from the member s ID card DECEMBER 2012 70 BlueCross BlueShield of South Carolina 276 277 Companion Guide Page 66 66 Loop ID 2200D 2200D Reference AMT AMT02 Name Claim Submitted Charges Monetary Amount Codes Notes Comments This segment is not required If the request does not specify a claim amount the value of this field may be a single 0 zero to return all claims If an amount is submitted and it matches a claim or claims found within the date range submitted for the provider specified all claims matching that dollar amount will be returned If no claims match that dollar amount all claims for the provider within the date range submitted will be returned 67 2200D DTP Claim Service Date This segment is required even when the request does not depend upon the service date 68 2200D DTP03 Claim Service Date To request information on claims regardless of date of service this field may be 20000101 CCYYMMDD where CCYYMMDD equals the request date This element is required when the subscriber is the patient DECEMBER 2012 71 BlueCross BlueShield of South Carolina 276 277 Companion Guide Page Loop ID Reference Name Codes Notes Comments 69 2210D SVC Service Line Information BlueCross BlueShield of South Carolina does not support line leve
25. and total charge Each request may contain one patient and one provider Because each request is specific to one patient and one provider only one DMG segment will appear in each request either 2000D DMG when the patient is the subscriber or 2000E DMG when the patient is a dependent When the subscriber is the patient the 2200D DTP segments are required When the patient is a dependent the 2200E AMT and DTP segments are required If BlueCross BlueShield of South Carolina is able to locate the Subscriber Identification Number submitted in the request but cannot determine the applicable patient on the contract it will return claims for all patients on the contract that match the submitted Provider Identification Number and fall within the submitted date of service range The AMT segment is not required If it is submitted the AMT02 element does not include an implied decimal point and leading zeros are suppressed For example to enter a claim amount of 100 00 the value of the AMT02 field will appear as 100 To enter 100 20 the amount will appear in the data stream as 100 2 Likewise 100 01 will appear in the field as 100 01 A maximum of 10 characters are allowed in this element The DTP segment is required even when the requestor does not want the claims filtered according to claim amount or service date In requests that do not have a total charge specified numbers 1 3 above the AMT02 element must contain a single 0 zero
26. cla Welcome to the password change facility Please enter your log in user id 1GWOBB1SC0 Please enter your current password enn nnn Please enter your new password Please enter your new password again Kornected 0 03 50 Wro sfttSz008W1 SFU APS IM cutee recede DECEMBER 2012 23 BlueCross BlueShield of South Carolina 276 277 Companion Guide 7 lf the password is valid you will get this screen Then just press ENTER to go back to the Main Menu REDI EDIGATEWAY TEST HyperTerminal Fie Edt View Cal Trasfer Help olej s13 ala Dies ig ll ah Please enter your log in user id 1GWO881SCO Please enter your current password Please enter your new password Please enter your new password again Sending command to change your password Command sent successfully Password changed successfully Password change process is complete Press any key to return to main menu Smeda N ISNT A ES cme eee 8 If your new password does not follow the masking rule this screen will appear and you will be sent back to the Main Menu e The masking rule is six to eight characters long and made up of alpha numeric characters REDI EDIGATEWAY TEST Hyper Term nal ipjxj Please enter your log in user id 1G6W0601SCOQ Please enter your current password Please enter your new password Please enter your new password again Sending command to change your passwor
27. comENV REG Where ENV Environment UNIT SYST QUAL PROD REG Region Specific host region if needed or default value if not SVCNAME Name of the Web service to be called 1 for MIME and SOAP DECEMBER 2012 38 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 14 4 Examples Here is an example of a real time request message using the HTTP MIME Multipart submission POST core eligibility HTTP 1 1 Host server_host server_port Content Length 2408 Content Type multipart form data boundary XbCY XbCY Content Disposition form data name PayloadT ype X12_270 Request_005010X279A1 XbCY Content Disposition form data name ProcessingMode RealTime XbCY Content Disposition form data name PayloadI D e51d4fae 7dec 11d0 a765 00a0c91 e6da 6 XbCY Content Disposition form data name TimeStamp 2007 08 30T 10 20 34Z XbCY Content Disposition form data name UserName hospa XbCY Content Disposition form data name Password 8y6dt3dd2 XbCY Content Disposition form data name Sender D HospitalA XbCY Content Disposition form data name ReceiverlD PayerB XbCY Content Disposition form data name CORERuleVersion 2 2 0 XbCY Content Disposition form data name Payload lt contents of file go here 1674 bytes long as specified above gt XbCY DECEMBER 2012 39 BlueCross BlueShield of South Carolina 276 277 Co
28. dr aaiae aa a sy fave nots sacued eves bacvi peas Aaaa aA AnNa cadet 36 4 13 Re TranSmission Procedures cccececscecececceeeeeeeeeeeeeseceeeeeegtaeaeaeseseseeeeetetatananaeaes 36 4 14 Communication Protocols ciccsadhenueescd coeds INAANAK A EE EEEIEI 37 4 14 1 Header Requirements cccceccececeeeceeneeeeceeneenereeneeneseeneeseneenenseneenensenennes 37 AVA 2 Error REPOIMING vi s ses ives edecueee cess ciivencdsGasevoedeveucvavnsheveckesvededeneetegatyrgenduaved es 38 4 143 Submission REieValivi costcesereevessdecuigivinsiversuepetesetieteasdavevdveseteteeieaeac iiaia 38 4 14 3 1 Real time 00 cece cececececececece cece eens eeeeeseeseeeeeaeeeeeseseseseeeeaeaeaeaeaeeesenenenanenaeas 38 A 143 2 Batehivcicice said etic te eine tieel Ni a eee wh AP ahaa eta 38 ATA A Exa Mp l ES ee nnna a A AT a EA A Aa a E ATEA 39 DECEMBER 2012 5 BlueCross BlueShield of South Carolina 276 277 Companion Guide 415 SOAP WSDL a iews ids ove aa aaa tn ceed Fathead aa a Cote eth 50 4 15 1 SOAP XML She Ma vescasa cs dedicsacacen ee awe cite ded nel vende cendcad endee a aa aaa iaia aaa 50 4 15 2 WSDL Information ccccececceeecececeeeeeceeeeeeeaeaeaeeeseeeeeeaeaeaeaeaeaesenenenenanaeas 50 445 3 SOAP Fault Formatting sessir reena a ienaa e hea rie RAe ri aenak 50 415 4 Error ReportiNg spiaire raara aaa aea aaa aaa a aa auaa daaa 52 4 15 5 SUbMISSION REtriCVAl ccececcececeeeeececeeeeeeeeaeaeaeaeseseeeegeaeaeauaeeesesenenesasaees 53 A 15 5 4
29. in the field Otherwise the total amount of the claim is entered The AMT02 element does not include an implied decimal point and leading zeros are suppressed For example to enter a claim amount of 100 00 the value of the AMT02 field will appear as 100 To enter 100 20 the amount will appear in the data stream as 100 2 Likewise 100 01 will appear in the field as 100 01 A maximum of 10 characters are allowed in this element To ensure that the request does not exclude any claims based upon date of service BlueCross recommends that the DTPO3 element in the 2200D or 2200E loop begin with 20000101 January 1 2000 and end with the last day of the current year request dater For DECEMBER 2012 2 BlueCross BlueShield of South Carolina 276 277 Companion Guide example when a request for claim status is sent on August 31 2009 the DTP line should appear as DTP 232 RD8 20000101 20090831 This date range ensures that all relevant claims are returned BlueCross BlueShield of South Carolina currently accepts one type of transaction per transmission Therefore all STO1 elements within the transmission will equal the same transaction number For example 14 276 transactions are acceptable within one enveloping sequence but 13 276s and one 8371 within one enveloping sequence is unacceptable DECEMBER 2012 3 BlueCross BlueShield of South Carolina 276 277 Companion Guide PREFACE This Companion Guide to the v5010 ASC X12 005010X
30. of South Carolina has specifically authorized Trading Partner under the terms of this Agreement b Not obtain access by any means to data Data Transmission Envelope or BlueCross BlueShield of South Carolina s Operating System for any purpose other than as BlueCross BlueShield of South Carolina has specifically granted Trading Partner access under this Agreement In the event that Trading Partner receives data or Data Transmissions not intended for Trading Partner Trading Partner will immediately notify BlueCross BlueShield of South Carolina and make arrangements to retransmit or otherwise return the data or Data Transmission to BlueCross BlueShield of South Carolina After such retransmission or return Trading Partner will immediately delete the data and Data Transmission from its Operating System c Protect and maintain the confidentiality of Security Access Codes issued to Trading Partner by BlueCross BlueShield of South Carolina and limit disclosure of Security Access Codes to authorized personnel on a need to know basis d Provide BlueCross BlueShield of South Carolina in writing all information requested in Exhibit A to this Agreement not later than Trading Partner s execution of this Agreement While this Agreement is in effect Trading Partner will notify BlueCross BlueShield of South Carolina in writing within one 1 business day of any material change in the information on Exhibit A to this Agreement BlueCross BlueShield of S
31. of a Batch Results Retrieval request message using the HTTP MIME Multipart envelope method POST core eligibility HTTP 1 1 Host server_host server_port Content Length 244508 Content Type multipart form data boundary XbCY XbCY Content Disposition form data name PayloadT ype X12_005010_Request_Batch_Results_271 XbCY Content Disposition form data name ProcessingMode Batch XbCY Content Disposition form data name Payload D 81d4fae 7dec 11d0 a765 00a0d91 e6fa6 XbCY Content Disposition form data name TimeStamp 2007 08 30T 10 20 34Z XbCY Content Disposition form data name UserName hospa XbCY Content Disposition form data name Password 8y6dt38dd2 XbCY Content Disposition form data name Sender D HospitalA XbCY Content Disposition form data name ReceiverlD PayerB XbCY Content Disposition form data name CORERuleVersion 2 2 0 XbCY DECEMBER 2012 45 BlueCross BlueShield of South Carolina 276 277 Companion Guide Here is an example of a Batch Retrieval Response message using the HTTP MIME Multipart envelope method HTTP 1 1 200 OK Content Length 12648 Content Type multipart form data boundary XbCY XbCY Content Disposition form data name PayloadT ype X12_271_Response_005010X279A1 XbCY Content Disposition form data name ProcessingMode Batch XbCY Content Disposition form data name P
32. or Type 10 12 3 byte extension ZIP Zipped files of any type ZIP will replace the 3 byte extension in the file name based on ZIP flag in our control file RSP EDIG proprietary claim responses RPT EDIG proprietary claim reports INV Invalid file response MSG Informational messages X12 X12 responses TA1 999 13 Period DECEMBER 2012 19 BlueCross BlueShield of South Carolina 276 277 Companion Guide Segment Position Description File 14 32 Identifies file s content Description 14 PTU Production P Test T or Unknown Indicator U Payer Name for Remittance Advice files X12 835s 15 18 Date Date the input file was received MMDD format 19 27 Original ISA Control Number The ISA Control Number of the first interchange group in the file 28 30 Not used Sample Set 1 Example of 837 claim response report and acknowledgment files In this example the first production file is an 837 sent January 25 2002 with one ISA IEA The file contained 235 claims and the ISA control number is ISACTRLO1 Example 1 is the file name containing ASC X12 TA1 example 2 is the file name containing ASC X12 999 returned to the trading partner example 3 is the file name containing EDIG proprietary claim response records and example 4 is the file name containing EDIG proprietary claim reports Sample Set 2 In this example the file received was an invalid file a possible read error or unzip error
33. return the SFTP VPN Customer Parameter Survey and attach your public key ID file to your email If you select TCPIP via VPN complete and return the BlueCross BlueShield of South Carolina Commercial TCPIP via VPN Customer Connectivity Parameter Survey and or the PGBA TCPIP via VPN Customer Connectivity Parameter Survey If you select NDM complete the BlueCross BlueShield of South Carolina Commercial NDM Customer Connectivity Parameter Survey and or the PGBA NDM Customer Connectivity Parameter Survey All Customer Connectivity Parameter Survey forms are in the Appendix of the EDI Gateway Technical Communications User s Manual Please complete and return the form to EDIG GUPPORT PalmettoGBA com Service Address Enter the trading partner s complete address including street city state and ZIP This address must be the physical location for your business DECEMBER 2012 77 BlueCross BlueShield of South Carolina 276 277 Companion Guide Billing Address If different from the service address enter the trading partner s billing or mailing address including street city state and ZIP Primary Contact s Information The name email address telephone number and fax number of the trading partner s primary contact This is the person BlueCross BlueShield of South Carolina EDIG will contact if there are questions regarding the enrollment or future questions about
34. the BlueCross BlueShield of South Carolina Supplemental Implementation Guides code sets data elements or formats for Data Transmissions set forth in Section 3 1 a of this Agreement c Provide Trading Partner with Security Access Codes that will allow Trading Partner to exchange Data Transmissions with BlueCross BlueShield of South Carolina s Operating System BlueCross BlueShield of South Carolina reserves the right to change Security Access Codes at any time and in such manner as BlueCross BlueShield of South Carolina in its sole discretion deems necessary IV PROVIDERS AND SUPPLIERS 4 1 Provider and Supplier Obligations Trading Partner will ensure that Providers and Suppliers will be bound by the mutual obligations of the Parties set forth in Section 3 1 and Trading Partner s obligations set forth in Section 3 2 even though Providers and Suppliers are not signatories to this Agreement 4 2 Responsibility for Providers and Suppliers Trading Partner is liable to BlueCross BlueShield of South Carolina for any act failure or omission of any Provider and or Supplier with whom Trading Partner contracts or for whom Trading Partner receives transmits stores or processes data or Data Transmissions or performs related activities as though the act failure or omission were that of Trading Partner 4 3 Notices Regarding Providers Trading Partner will notify BlueCross BlueShield of South Carolina at least fourteen 14 days prior to the
35. the Parties on this specific subject matter In the event of any inconsistency between any provision of this Agreement and any provision of a Rider to this Agreement the provision of this Agreement controls Automatic Amendment for Regulatory Compliance This Agreement will automatically amend to comply with any final regulation or amendment to a final regulation adopted by HHS concerning the subject matter of this Agreement upon the effective date of the final regulation or amendment Survival The provisions of Sections 3 1 d and 3 2 Article V Sections 6 1 and 6 2 and Article VIII will survive termination of this Agreement DECEMBER 2012 102 BlueCross BlueShield of South Carolina 276 277 Companion Guide SIGNATURES The Parties will be bound by all the terms provisions and conditions of this Agreement upon execution of the Agreement by each Party s authorized representative Agreed to Agreed to TRADING PARTNER BLUE CROSS AND BLUE SHIELD OF SOUTH CAROLINA INC By By Name Name Title Title Address I 20 at Alpine Road AA 270 City State ZIP Columbia SC 29219 Date Date Contact Contact Title Title Telephone _ Telephone _ PLEASE NOTE Trading Partner must complete and return Exhibit A with this signed Electronic Trading Partner Agreement 1 Accredited Standards Committee X12 Insurance Subcommittee ASC X12N Health Care Claim Status Request 276 005010X212 Washington Publishing Company Ap
36. to time Transaction Rules the submission and payment of claims for medical services and supplies rendered or sold to Covered Individuals by Providers NOW THEREFORE in consideration for the mutual promises herein the Parties agree as follows I DEFINITIONS The following terms with initial capitals have these meanings 1 1 ANSI means American National Standards Institute an organization whose Accredited Standards Committee develops and approves uniform standards for the electronic interchange of business transactions 1 2 Business Associate means an entity meeting the definition of 45 C F R Part 160 103 1 3 Confidential Health Information means information relating to specific Individuals including Individually Identifiable Health Information and Health Information that is exchanged by and between BlueCross BlueShield of South Carolina and Trading Partner or Providers for various business purposes and that is protected from disclosure to unauthorized persons or entities by Social Security Act 1171 et seq the Standards for Privacy of Individually Identifiable Health Information 45 C F R Parts 160 and 164 the Privacy Act of 1974 5 U S C 552A or other applicable state and federal statutes and regulations including statutes and regulations protecting the privacy of general medical mental health and substance abuse records collectively Privacy Statutes and Regulations 1 4 Covered Individual means an Individ
37. transmitting once the ID numbers are received DECEMBER 2012 65 BlueCross BlueShield of South Carolina 276 277 Companion Guide 9 5 Enrollment for Providers Using a Clearinghouse Providers who will use a vendor or clearinghouse for submission of claims should complete only the Trading Partner Agreement portion of the agreement for health care professionals Mail the agreement to the address indicated at the bottom of the form Once the completed agreement is received by the Technology Support Center an authorized representative will review and sign the Trading Partner Agreement file the original and return a copy of the agreement to the Trading Partner If you have further questions about the enrollment process contact us by visiting www hipaacriticalcenter com contactus aspx DECEMBER 2012 66 BlueCross BlueShield of South Carolina 276 277 Companion Guide 10 Transaction Specific Information This section describes how ASC X12N Implementation Guides IGs adopted under HIPAA will be detailed with the use of a table 1 2 The tables contain a row for each segment that BlueCross BlueShield of South Carolina and its subsidiaries health plans have something additional over and above the information in the IGs That information can 1 Limit the repeat of loops or segments 2 Limit the length of a simple data element 3 Specify a sub set of the IGs internal code listings 4 Clarify the use of loops segments composit
38. user friendly automation checkpoint restart error recovery and security Connect Direct software offers choices in operating systems UNIX Windows and Z OS EDI files submitted through the SFTP VPN and NDM communication methods can either be segmented one segment per line with a valid non special character delimiter or a 1000 byte wrapped EDI format with each ISA starting in a new line Here are claims dataset naming conventions and attributes for X12 transactions X12 Production Dataset Names should be BC HEDI NDM INP TP ID and a generation data group TP ID is an eight character EDIG assigned value associated with the EDIG assigned trading partner ID BlueCross BlueShield of South Carolina Commercial Example Trading Partner ID CGWO0000SCO0 TP ID C0000SC0 PGBA Example Trading Partner ID 7 W0000SCO TP ID SOOOOSCO X12 Dataset Attributes DISP NEW CATLG DELETE UNIT SYSDG SPACE CYL 75 10 RLSE DECEMBER 2012 31 BlueCross BlueShield of South Carolina 276 277 Companion Guide DCB RECFM FB LRECL 1000 BLKSIZE 27000 4 9 TCPIP The trading partners choosing this method will connect through a VPN Concentrator or AT amp T s AGNS network to BlueCross BlueShield of South Carolina s eServer The trading partner will deploy an application for its server that will initiate a transaction via socket x to socket y on BlueCross BlueShield of South Carolina s server This application must acquire the socket conne
39. 11 Repetition Separator Populated by EDIG ISA12 Interchange Control Version 00501 Number ISA13 Interchange Control Number Assigned by EDIG ISA14 Acknowledgment Requested 1 ISA15 Usage Indicator P T production or test indicator ISA16 Component Element Populated by EDIG GS01 Functional Identifier Populated by EDIG GS02 Application Sender s Code Sending entity s U S Federal Tax Identification Number or another mutually agreed to sender identifying code GS03 Application Receiver s Code If 271 277 or 278 transaction GS03 will be the same value of the associated inbound 270 276 or 278 GSO2 If 999 TA1 or EDIG claim response GS03 will be the same value of the associated inbound transaction s GS02 Otherwise value is EDIG assigned Trading Partner ID GS04 Date Populated by EDIG GS05 Time Populated by EDIG GS06 Group Control Number Assigned by EDIG GS07 Responsible Agency Code X GS08 Version Release Industry Populated by EDIG Identifier Code BlueCross BlueShield of South Carolina and Subsidiaries Entity Federal TIN BlueCross BlueShield of South Carolina includes FEP State 570287419 BlueChoice HealthPlan 570768835 PGBA TRICARE 571132733 DECEMBER 2012 58 BlueCross BlueShield of South Carolina 276 277 Companion Guide 7 PAYER SPECIFIC BUSINESSS RULES AND LIMITATIONS 7 1 Supported Service Types BlueCross BlueShield of South Carolina supports these 276 Service T
40. 212 Health Care Claim Status Requests 276 Implementation Guides and associated errata adopted under HIPAA clarifies and specifies the data content when exchanging electronically with BlueCross BlueShield of South Carolina and its subsidiaries Health Plan Transmissions based on this companion guide used in tandem with the v5010 ASC X12 005010X212 Health Care Claim Status Requests 276 Implementation Guides are compliant with both ASC X12 syntax and those guides This Companion Guide is intended to convey information that is within the framework of the ASC X12 005010X212 Health Care Claim Status Requests 276 Implementation Guides adopted for use under HIPAA The Companion Guide is not intended to convey information that in any way exceeds the requirements or usages of data expressed in the Implementation Guides DECEMBER 2012 4 BlueCross BlueShield of South Carolina 276 277 Companion Guide Table of Contents 1 INTRODUCTION vise stesdexieces ves a A l dade covebb elas EE EREET NEDENE eevee Ea 7 UT oO te constucationecbeleteseusstarietecenttaanteniebtestutecsntasistioecatesoheacacbtaetedeceedteacttecseeeat tens 7 TD QVEINVIOW E AEA E A He E T A ueeduianbad E to 7 424 What lS CAQH araea a aa Ta aAA Coes eos a ore ess 7 dc S RETEFENCES ci oscscse tle aa ach a AS iain died Races am ena a aa a aa AEE aY 7 1 3 1 ASC X12 Version 5010A1 Implementation Guides ccc eeeeee ee ee ee eeeeeeeeeeenaenees 7 1 3 2 BlueCross BlueShield of Sout
41. 279A1 XbCY Content Disposition form data name ProcessingMode Batch XbCY Content Disposition form data name Payload D 81d4fae 7dec 11d0 a765 00a0d91 e6fa 6 XbCY Content Disposition form data name PayloadLength 10240 XbCY Content Disposition form data name TimeStamp 2007 08 30T 10 20 34Z XbCY Content Disposition form data name UserName hospa XbCY Content Disposition form data name Password 8y6dt38dd2 XbCY Content Disposition form data name Sender D HospitalA XbCY Content Disposition form data name ReceiverlD PayerB XbCY Content Disposition form data name CORERuleVersion 2 2 0 XbCY Content Disposition form data name Checksum 6A3FE55946 XbCY Content Disposition form data name Payload lt contents of batch file go here gt XbCY DECEMBER 2012 41 BlueCross BlueShield of South Carolina 276 277 Companion Guide Here is an example of a synchronous response to a Batch Submission request message using the HTTP MIME Multipart envelope method HTTP 1 1 200 OK Content Length 2408 Content Type multipart form data boundary XbCY XbCY Content Disposition form data name PayloadT ype X12_BatchReceiptConfirmation XbCY Content Disposition form data name ProcessingMode Batch XbCY Content Disposition form data name Payload D 81d4fae 7dec 11d0 a765 00a0c91 e6da 6
42. 3 2l l GATEWAY PRODUCTION NETWORK GPNet Corporate CT EDI Gateway For technical assistance contact the appropriate Technology Support Center Blue Cross Blue Shield Of South Carolina 1 800 868 2505 KKEKKAKKKKKKKKKAKKAKKAKKKAKAKAKKAKAKAKAKKARAKAKKKAKKRKKKKRAKKKKAKKKAKKRKKKAKKRKKKKRKREE Welcome to GPNet Production Server Please Login 1GHWOOOOSC1 Password Connected 0 00 22 Auto detect 384008 N 1 SCROLL CAPS NUM Capture Print echo Figure 5 GPNet Welcome Login Screen You must enter the ID and password in capital letters To log in 1 Type your User ID and press ENTER Note To log into the Test Server use your user ID with the Q on the end To log into the Production Server use your user ID with the number on the end 2 Type your password The password will not display on the screen as you type it When you have finished typing press ENTER 3 The system will allow three invalid login attempts before it terminates the session Also the system will automatically log you off after approximately two minutes of inactivity For assistance with password issues please contact the BlueCross BlueShield of South Carolina Technology Support Center at 800 868 2505 or 803 736 5980 DECEMBER 2012 14 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 3 1 Messages After the User ID and password are validated the Message screen displays Figure 6 REDI EDIGATEWAY PRODUCTION
43. BLUECROSS BLUESHIELD OF SOUTH CAROLINA ASC X12N 276 005010X212A1 HEALTH CARE CLAIM STATUS REQUEST PHASE Il SYSTEM COMPANION GUIDE VERSION 1 1 DECEMBER 2012 BlueCross BlueShield of South Carolina 276 277 Companion Guide DISCLOSURE STATEMENT Please note that the information in this guide is subject to change Any changes will be available at www SouthCarolinaBlues com This transaction se t can be used to inquire about the eligibility coverage or benefits associated with a benefit plan employer plan sponsor subscriber or a dependent under the subscriber s policy The transaction set is intended to be used by all lines of insurance such as health life and property and casualty The information describes specific requirements for processing BlueCross BlueShield of South Carolina HIPAA ASC X12 005010X212 Health Care Claim Status Requests 276 submitted via EDI Electronic Data Interchange 1 2 BlueCross BlueShield of South Carolina accepts these general claim status inquiries 1 All claim header and line information for a specific patient and provider 2 All claim header and line information for a specific patient provider and claim number 3 All claim header and line information for a specific patient provider and service date range 4 All claim header and line information for a specific patient provider and total charge 5 All claim header and line information for a specific patient provider service date range
44. BlueShield of South Carolina in the conduct of its business activities that is not normally made available to BlueCross BlueShield of South Carolina s customers competitors or third parties the disclosure of which will or may impair BlueCross BlueShield of South Carolina s competitive position or otherwise prejudice BlueCross BlueShield of South Carolina s ongoing business DECEMBER 2012 94 BlueCross BlueShield of South Carolina 276 277 Companion Guide 1 16 1 20 Provider means a hospital or professional practitioner duly certified or licensed to provide health care services to Covered Individuals and includes without limitation extended care facilities skilled nursing facilities rehabilitation facilities home health agencies hospices physicians dentists clinical social workers ambulance services and hospitals or professional practitioners specifically certified or approved by HHS to provide reimbursable health care services to Medicare Eligible Individuals Security Access Codes mean alphanumeric codes that BlueCross BlueShield of South Carolina assigns to Trading Partner to allow Trading Partner access to BlueCross BlueShield of South Carolina s Operating System for the purpose of successfully executing Data Transmissions or otherwise carrying out this Agreement Source Documents mean documents containing Data that are or may be required as part of a Data Transmission concerning a claim for payment of charges for medical
45. Estimates Transmission YN Li Li ASC X12N 270 005010X279A1 7 fwk ASC X12N 8371 005010X223A2 ASC X12N 271 005010X279A1 m fwk ASC X12N 837P 005010X222A1 ASC X12N 276 005010X212 fwk ASC X12N 837D 005010X224A2 ASC X12N 277 005010X212 fwk ASC X12N 835 005010X221A1 ASC X12N 278 005010X217 e fwk ASC X12N 834 005010X220A1 Versions supported as of 10 16 2003 t Average number of transactions per week Yes No For every box you checked Y provide the average of transactions to be submitted weekly poog M Vendor s Information If a vendor s software is used to create ASC X12N transactions submitted to the EDI Gateway please provide the vendor s name and address and list the transactions Vendor s Name Address 1 Address 2 City State ZIP Transactions Customer s Information If your business is authonzed to send or receive transactions on behalf of another entity please provide the entity s name federal tax identification number and national provider identifier number This is required for all transactions C a i N DECEMBER 2012 o 0 BlueCross BlueShield of South Carolina 276 277 Companion Guide Website Address URL If you are a clearinghouse or software vendor and would like to be added to the Thumbs Up Certified Vendor list on www SouthCarolinaBlues com please provide this information 1 Additional Contact
46. Extracorporeal Shock Wave Lithotripter ESWL Unit 4L Genetic Counseling Screening Services 4M Adult Day Care Program Facility 4N Alzheimer s Diagnostic Assessment Services 40 Comprehensive Geriatric Assessment Facility 4P Emergency Response Geriatric Unit 4Q Geriatric Acute Care Unit 4R Geriatric Clinics 4S Respite Care Facility 4U Patient Education Unit 4V Community Health Promotion Facility 4W Worksite Health Promotion Facility 4X Hemodialysis Facility 4Y Home Health Services 4Z Hospice 5A Medical Surgical or Other Intensive Care Unit 5B Hisopathology Laboratory 5C Blood Bank 5D Neonatal Intensive Care Unit 5E Obstetrics Unit 5F Occupational Health Services 5G Organized Outpatient Services 5H Pediatric Acute Inpatient Unit 5I Psychiatric Child Adolescent Services 5J Psychiatric Consultation Liaison Services 5K Psychiatric Education Services 5L Psychiatric Emergency Services 5M Psychiatric Geriatric Services 5N Psychiatric Inpatient Unit 50 Psychiatric Outpatient Services 5P Psychiatric Partial Hospitalization Program 5Q Megavoltage Radiation Therapy Unit 5R Radioactive Implants Unit DECEMBER 2012 5S Therapeutic Radioisotope Facility 60 BlueCross BlueShield of South Carolina 276 277 Companion Guide 5T X Ray Radiation Therapy Unit 5U CT Scanner Unit 5V Diagnosti
47. Information First Last Name Telephone __ 2 Additional Contact Information First Last Name Telephone 3 Additional Contact Information FirstLast Name Telephone 4 Additional Contact Information First Last Name Telephone DECEMBER 2012 Salesperson s Name and Telephone If you would like to provide additional contact information please do so here On the description line give a brief explanation or purpose for the additional contact Additional Contact Information ext 81 BlueCross BlueShield of South Carolina 276 277 Companion Guide E1 Clearinghouse Trading Partner Agreement CLEARINGHOUSE ELECTRONIC TRADING PARTNER AGREEMENT Agreement No This Electronic Trading Partner Agreement Agreement is entered into as of the day of 2012 Effective Date by and between BlueCross BlueShield of South Carolina and its subsidiaries and Trading Partner RECITALS WHEREAS Trading Partner acts as a Business Associate to certain Providers and submits electronic transactions to BlueCross BlueShield of South Carolina on behalf of such Providers and WHEREAS both Parties are entering into this Agreement to facilitate through transmission via electronic formats consistent with or otherwise allowed by Social Security Act 1173 and the Standards for Electronic Transactions 45 C F R Parts 160 and 162 as may be amended or modified from time
48. MBER 2012 29 BlueCross BlueShield of South Carolina 276 277 Companion Guide g If you would like to retrieve your immediate response type cd and go to step B of the Download Files Using FTP instructions 2 To exit the FTP process type bye and press ENTER 3 To exit MS DOS type exit at the prompt and press ENTER 4 To end your modem connection find Connected to Trail Blazer the blinking modem signal on your Windows Taskbar at the bottom right ao Connected at 26 400 bps Duration 000 00 06 of the screen Click this symbol and the Connect Status box will open Bytes received 1 131 _Disgonnect Figure 21 Click on Disconnect Bytes sent 4 945 Details gt gt Figure 21 Connection Status Window 4 6 2 Downloading Files Using FTP 1 To download a file after connecting to the FTP FXF begin by changing directories to the outbound mailbox and list the files available for download a At the ftp gt prompt type bin and press ENTER ftp gt bin 200 Type set to I b Type cd outbound and press ENTER ftp gt cd outbound 250 CWD Command Successful c Type Is and press ENTER You will see the file list information 200 PORT command successtul 150 Opening data connection for X1200001 ZIP ISACTRLOOO1 X1200002 ZIP ISACTRLOOO1 226 Transfer complete ftp gt d After determining which file you want to download enter in the download command get and the file name at the ftp gt prompt ftp gt get X1200001
49. Net icon b z Make Neve Figure 17 Dial Up Networking Folder 7 The Connect To window will open s Connect To Hx Figure 18 Type in the GPNet router user name and password you will aa ame receive this information during connectivity testing Note The user Username name and password are case sensitive Passwort Click Connect I Save password Phone number 7886705 Dialing from Default Location Dial Properties Figure 18 Connect To Window DECEMBER 2012 28 BlueCross BlueShield of South Carolina 276 277 Companion Guide 8 Your modem will dial and the screen shown in Figure 19 will display when the connection is established Click Close 9 Use MS DOS to make a connection Connection Established 2 x You are connected to Trail Blazer To disconnect or to view status information double click the dial up icon in the status area a Open a DOS prompt eee b Type ftp at the prompt and press ENTER c At the ftp gt prompt type open 192 168 103 135 2021 for production or 192 168 103 137 2021 for test and press ENTER You will see the connection information shown in Figure 20 You can also double click the connection icon SI lt in the Dial Up Networking folder a T Do not show this dialog box in the future Figure 19 Connection Established Window eS Shortcut to CMD ftp Microsoft Windows KP Version 5 1 2609 lt G gt Copyright 1985 2081 Microsoft Corp
50. REAFUME oi siura aaeain aa ieee a AENEA leas 53 41552 Baten kestosiceavcectatecveutecutaniadhersbvedesetestshetiatarebaidecetead che Eua EA AET aE 53 4 15 5 3 SOAP Header ynin ira aruna cieeddacavscened Nose uebevtienavscuaed TEA ENT iena 53 ATSA SOAR SamplewFaulUetccste caa a a a A E A a aA 54 4 16 General Specifications Applicable to Both Envelope Methods ccscseeeeeeeeeeeeeeeaees 55 4 16 1 Request and Response Handling ccceecee cece cece eeeeeeeeeeateeeeeeeeeaeaeeeeeeeeeeaeanes 55 4 16 2 Submitter Authentication and Authorization Handling eeeeeeeeeeeeeeeeees 55 5 CONTACT INFORMATION acc ccvextercsisouteseteawenca estat naaa aa cbagy aariaa eee et eadonde es da eee 56 5 1 EDI Customer Service and Technical Assistance cece ee eeeee eee ee eee e este eeeeeeeaeeaeeenaenas 56 5 2 Provider Servite NUMBDCMascicce ins oaeen i ron ERE KAE RI AAEE teaee sities ones 56 5 3 Applicable Web Email Contact Information ccccceeeee ee eeee eee teen eee ea sean ee eaeeeeaeeaeees 56 6 CONTROL SEGMENTS ENVELOPES ccececeeeeeeececesecececeeaceeaeeeeeseeeseeasaseeaeaeaesesesenenees 57 6 1 EDIG Specifications for Enveloping X12 Transactions ccccceceeceeeeeeseeeaeeeeeeeeeeeeaeaes 57 6 2 X12 OUTDOUNC TraNnSa ctiOns e ee a e e eee nee ene EE NET nade neta eens nanan 58 7 PAYER SPECIFIC BUSINESSS RULES AND LIMITATIONS ccccececeeeeeeeeeeeeeeeeseseseeaeeeeeaeees 59 7 1 Supported Service TYPES seisevcec
51. SS AND BLUE and conditions of this Agreement upon execution of SHIELD OF SOUTH CAROLINA INC the Agreement by each Party s authorized representative Agreed to TRADING PARTNER By By Name Name Title Title Address I 20 at Alpine Road AA 270 City State ZIP Columbia SC 29219 Date Date Contact Contact Title Title Telephone _ Telephone _ DECEMBER 2012 BlueCross BlueShield of South Carolina 276 277 Companion Guide F1 Hospital amp Healthcare Professional Agreement Hospital amp Healthcare Professional ELECTRONIC TRADING PARTNER AGREEMENT Agreement No This Electronic Trading Partner Agreement Agreement is made as of the day of J 2012 Effective Date by and between BlueCross BlueShield of South Carolina Inc a South Carolina corporation located at I 20 Alpine Road AA 270 Columbia South Carolina 29219 and Trading Partner located at RECITALS WHEREAS Trading Partner is a business entity that transacts business with BlueCross BlueShield of South Carolina on a regular basis pursuant to the terms of a Business Agreement and WHEREAS both Parties are entering into this Agreement to facilitate through transmission via electronic formats consistent with or otherwise allowed by Social Security Act 1173 and the Standards for Electronic Transactions 45 C F R Parts 160 and 162 as may be amended or modified from time to time
52. Tax Identification Number Must be same as ISA08 GS04 Date Populated by trading partner GS05 Time Populated by trading partner GS06 Group Control Number Assigned by trading partner value must remain unique for one year GS07 Responsible Agency Code X GS08 Version Release Industry Code populated by trading partner Identifier BlueCross BlueShield of South Carolina and Subsidiaries Entity Federal TIN Entity Federal TIN BlueCross BlueShield of South Carolina 570287419 Thomas H Cooper amp Company TCC 571032566 BlueChoice HealthPlan 570768835 Florida Combined Life FCL 592876465 Carolina Benefit Administrators 571001631 PGBA TRICARE 571132733 Companion Life Insurance Company 570523959 PGBA Bureau of Prisons 530205705 Employee Benefit Administrators 561939146 PGBA Humana Veteran Healthcare Services 208418853 Planned Administrators Incorporated 570718839 PAI Note Additional explanations are available in the ASC X12 Standards for Electronic Data Interchange Technical Report Type 3 The ASC X12 TR3s that detail the full requirements for these transactions are available at http store x12 org store Because Companion Life and Florida Combined Life are separate life insurance companies from BlueCross Florida Combined Life and Companion Life will be responsible for all services related to life insurance PAI and TCC are separate companies that provide third party administrative services on behalf of BlueCross
53. XbCY Content Disposition form data name TimeStamp 2007 08 30T 10 20 34Z XbCY Content Disposition form data name Sender D PayerB XbCY Content Disposition form data name ReceiverlD HospitalA XbCY Content Disposition form data name CORERuleVersion 2 2 0 XbCY Content Disposition form data name ErrorCode Success XbCY Content Disposition form data name ErrorMessage None XbC Y DECEMBER 2012 42 BlueCross BlueShield of South Carolina 276 277 Companion Guide Here is an example of a Batch Submission Acknowledgement Retrieval request message using the HTTP MIME Multipart envelope method POST core eligibility HTTP 1 1 Host server_host server_port Content Length 244508 Content Type multipart form data boundary XbCY XbCY Content Disposition form data name PayloadT ype X12_999 RetrievalRequest_005010X231A1 XbCY Content Disposition form data name ProcessingMode Batch XbCY Content Disposition form data name Payload D 81d4fae 7dec 1 1d0 a765 00a0d91 e6fa6 XbCY Content Disposition form data name TimeStamp 2007 08 30T10 20 34Z XbCY Content Disposition form data name UserName hospa XbCY Content Disposition form data name Password 8y6dt3dd2 XbCY Content Disposition form data name Sender D HospitalA XbCY Content Disposition form data name Receiver D PayerB XbCY
54. XbCY Content Disposition form data name TimeStamp 2007 08 30T 10 20 34Z XbCY Content Disposition form data name UserName hospa XbCY Content Disposition form data name Password 8y6dt38dd2 XbCY Content Disposition form data name Sender D HospitalA XbCY Content Disposition form data name ReceiverlD PayerB XbCY Content Disposition form data name CORERuleVersion 2 2 0 XbCY Content Disposition form data name Checksum 6A3FE55946 XbCY Content Disposition form data name Payload lt contents of batch file go here gt XbCY DECEMBER 2012 47 BlueCross BlueShield of South Carolina 276 277 Companion Guide Here is an example of a Batch Results Acknowledgement Submission Response message using the HTTP MIME Multipart envelope method HTTP 1 1 200 OK Content Length 2408 Content Type multipart form data boundary XbCY XbCY Content Disposition form data name PayloadT ype X12_Response_ConfirmReceiptReceived XbCY Content Disposition form data name ProcessingMode Batch XbCY Content Disposition form data name PayloadI D 81d4fae 7dec 11d0 a765 00a0d91 e6fa 6 XbCY Content Disposition form data name TimeStamp 2007 08 30T 10 20 34Z XbCY Content Disposition form data name Sender D PayerB XbCY Content Disposition form data name ReceiverlD HospitalA XbCY Content Dispositio
55. a issues to Trading Partner will when affixed to Data Transmissions be legally sufficient to verify the identity of the transmitter and to authenticate the Data Transmission thereby establishing the Data Transmission s validity Data Transmissions having a Security Access Code affixed to them will be deemed to have been written or signed by the sender Computer printouts of the information contained in such correspondence and documents that have been electronically or magnetically recorded and kept in the normal course of the sender s or receiver s business will be considered original business records admissible in any judicial arbitration mediation or administrative proceeding to the same extent and under the same conditions as other business records originated and maintained in documentary form 3 2 Trading Partner Obligations Trading Partner will DECEMBER 2012 85 BlueCross BlueShield of South Carolina 276 277 Companion Guide a Not copy reverse engineer disclose publish distribute alter or use Data Data Transmission or Envelope for any purpose other than for which BlueCross BlueShield of South Carolina has specifically authorized Trading Partner under the terms of this Agreement b Not obtain access by any means to data Data Transmission Envelope or BlueCross BlueShield of South Carolina s Operating System for any purpose other than as BlueCross BlueShield of South Carolina has specifically granted Trading
56. addition or deletion of any Provider and or Supplier from the list contained in Exhibit A of Providers and Suppliers for whom Trading Partner submits data or Data Transmissions to BlueCross BlueShield of South Carolina DECEMBER 2012 86 BlueCross BlueShield of South Carolina 276 277 Companion Guide V CONFIDENTIALITY AND SECURITY 5 1 Data Security Trading Partner will maintain adequate security procedures to prevent unauthorized access to data Data Transmissions Security Access Codes Envelopes backup files Source Documents or BlueCross BlueShield of South Carolina s Operating System Trading Partner will immediately notify BlueCross BlueShield of South Carolina of any unauthorized attempt to obtain access to or otherwise tamper with data Data Transmissions Security Access Codes Envelopes backup files Source Documents or BlueCross BlueShield of South Carolina s Operating System a Confidential Health Information Trading Partner will comply with all applicable Privacy Statutes and Regulations guidelines and health care industry customs concerning treatment of Confidential Health Information b Proprietary Information Trading Partner will treat BlueCross BlueShield of South Carolina s Proprietary Information obtained or learned in connection with this Agreement as confidential and will not use BlueCross BlueShield of South Carolina s Proprietary Information for Trading Partner s own commercial benefit or any other purpos
57. aintain adequate security procedures to prevent unauthorized access to data Data Transmissions Security Access Codes Envelope backup files Source Documents or BlueCross BlueShield of South Carolina s Operating System Trading Partner will immediately notify BlueCross BlueShield of South Carolina of any unauthorized attempt to obtain access to or otherwise tamper with data Data Transmissions Security Access Codes Envelope backup files Source Documents or BlueCross BlueShield of South Carolina s Operating System a Confidential Health Information Trading Partner will comply with all applicable Privacy Statutes and Regulations guidelines and health care industry customs concerning treatment of Confidential Health Information b Proprietary Information Trading Partner will treat BlueCross BlueShield of South Carolina s Proprietary Information obtained or learned in connection with this Agreement as confidential and will not use BlueCross BlueShield of South Carolina s Proprietary Information for Trading Partner s own commercial benefit or any other purpose not authorized in this Agreement Trading Partner will safeguard BlueCross BlueShield of South Carolina s Proprietary Information against unauthorized disclosure and use c Notice of Unauthorized Disclosures and Uses Trading Partner will promptly notify BlueCross BlueShield of South Carolina of any unlawful or unauthorized use or disclosure of Confidential Health Information o
58. an to use a vendor or clearinghouse to conduct your HIPAA transactions please have them contact us by visiting www hipaacriticalcenter com contactus aspx as soon as possible if they have not already done so to ensure their transactions are compatible with our systems You still must meet the separate HIPAA privacy rules that went into effect on April 14 2003 DECEMBER 2012 75 BlueCross BlueShield of South Carolina 276 277 Companion Guide D1 Trading Partner Enrollment Enrollment with the EDI Gateway requires prospective trading partners to complete and submit the BlueCross BlueShield of South Carolina EDIG Trading Partner Enrollment Form and the Trading Partner Agreement The purpose of the BlueCross BlueShield of South Carolina EDIG Trading Partner Enrollment Form is to enroll providers software vendors clearinghouses and billing services as trading partners and recipients of electronic data It is important you follow these instructions and complete all the required information We will return incomplete forms to the applicant which could delay the enrollment process The enrollment form is in the Appendix of the EDI Gateway Technical Communications User s Manual and is also available at the HIPAA Critical Center You should complete enrollment forms electronically and email them to EDIG OPS PalmettoGBA com Use your TAB key to move forward through the form fields or click your cursor in a desired field or box Be sure to save the file afte
59. anatsenenstaeaeesesnanats 75 D1 Trading Partner Enrollment ccc cece ee eee eee eee eee eee ease eee nena ease eee eee 76 E1 Clearinghouse Trading Partner Agreement cceceee eee ee eee ee ee ee cece eens eee cance eaeeeeeeaeaes 82 F1 Hospital amp Healthcare Professional ASre MENt cceececeee cece cece eeeeeeeeeecaeeeseeeeeaeees 93 DECEMBER 2012 6 BlueCross BlueShield of South Carolina 276 277 Companion Guide 1 INTRODUCTION This application for real time and batch 276 277s follows the CAQH Phase II guidelines 1 1 Scope Providers billing services and clearinghouses are advised to use the ASC X12 005010X212 Health Care Claim Status Requests 276 Implementation Guide as a basis for their submission of Eligibility and Benefit inquiries This companion document should be used to clarify the business rules for 276 277 data content requirements batch and real time acknowledgment connectivity response time and system availability specifically for submissions through the system These rules differ from the Companion Guide for submissions via BlueCross BlueShield of South Carolinas EC Gateway connection This document is intended for use with CAQH compliant systems 1 2 Overview The purpose of this document is to introduce and provide information about BlueCross BlueShield of South Carolinas CAQH solution for submitting real time 276 277 transactions 1 2 1 What Ils CAQH CAQH stands for the Council for Affor
60. ar Nose and Throat Facility 3F Rehabilitation Facility 3G Orthopedic Facility 3H Chronic Disease Facility 3l Other Specialty Facility 3J Children s General Facility 3K Children s Hospital Unit of an Institution 3L Children s Psychiatric Facility 3M Children s Tuberculosis and Other Respiratory Diseases Facility 3N Children s Eye Ear Nose and Throat Facility DECEMBER 2012 59 BlueCross BlueShield of South Carolina 276 277 Companion Guide 30 Children s Rehabilitation Facility 3P Children s Orthopedic Facility 3Q Children s Chronic Disease Facility 3R Children s Other Specialty Facility 3S Institution for Mental Retardation 3T Alcoholism and Other Chemical Dependency Facility 3U General Inpatient Care for AIDS ARC Facility 3V AIDS ARC Unit 3W Specialized Outpatient Program for AIDS ARC 3X Alcohol Drug Abuse or Dependency Inpatient Unit 3Y Alcohol Drug Abuse or Dependency Outpatient Services 3Z Arthritis Treatment Center 40 Receiver 43 Claimant Authorized Representative 44 Data Processing Service Bureau 4A Birthing Room LDRP Room 4B Burn Care Unit 4C Cardiac Catherization Laboratory 4D Open Heart Surgery Facility 4E Cardiac Intensive Care Unit 4F Angioplasty Facility 4G Chronic Obstructive Pulmonary Disease Service Facility 4H Emergency Department 4l Trauma Center Certified 4J
61. artner transmits to or receives from BlueCross BlueShield of South Carolina for not less than six 6 years from the date that Trading Partner transmits or receives them All retained records will be subject to the same security measures as data and Data Transmissions 6 2 Trade Data Log BlueCross BlueShield of South Carolina and Trading Partner will each establish and maintain a Trade Data Log to record all Data Transmissions between the Parties during the term of this Agreement Each Party will take necessary and reasonable steps to ensure that its Trade Data Log constitutes a complete accurate and unaltered record of each Data Transmission between the Parties Each Party will retain Data Transmission records for not less than twenty four 24 month s following the date of a Data Transmission Each Party will maintain its Trade Data Log on computer media or other suitable means that permit timely retrieval and presentation in readable form 6 3 Right to Audit BlueCross BlueShield of South Carolina will have the right to audit relevant Trading Partner s business records Trading Partner s Trade Data Log and Trading Partner s DECEMBER 2012 87 BlueCross BlueShield of South Carolina 276 277 Companion Guide Operating System as BlueCross BlueShield of South Carolina in its sole discretion deems necessary to ensure compliance with this Agreement 6 4 Government Requests for Information Trading Partner will notify BlueCross BlueShield of
62. at its own expense its own Operating System necessary for timely complete accurate and secure Data Transmission pursuant to this Agreement Each Party will pay its own costs related to Data Transmission under this Agreement including without limitation charges for the Party s own Operating System equipment software and services maintaining an electronic mailbox connection time terminals connections telephones modems and applicable minimum use charges Each Party will be responsible for its own expenses incurred for translating formatting and sending or receiving communications over the electronic network to any electronic mailbox of the other Party Backup Files Each Party will maintain adequate backup files electronic tapes or other sufficient means to recreate a Data Transmission for at least six 6 years from the Data Transmission s creation date Such backup files tapes or other sufficient means will be subject to the terms of Article V of this Agreement to the same extent as the original Data Transmission Data and Data Transmission Security BlueCross BlueShield of South Carolina and Trading Partner will employ security measures necessary to protect Data and Data Transmissions between them including authentication encryption password use or other security measures in compliance with Social Security Act 1173 d and any HHS implementing regulations or guidelines and as set forth in Article V of this Agreement Unless BlueC
63. ayload D 81d4fae 7dec 11d0 a765 00a0c91 e6da 6 XbCY Content Disposition form data name PayloadLength 10240 XbCY Content Disposition form data name TimeStamp 2007 08 30T 10 20 34Z XbCY Content Disposition form data name Sender D PayerB XbCY Content Disposition form data name Receiver D HospitalA XbCY Content Disposition form data name CORERuleVersion 2 2 0 None XbCY Content Disposition form data name Checksum 6A3FE55946 XbCY Content Disposition form data name Payload lt contents of batch file go here gt XbCY Content Disposition form data name ErrorCode Success XbCY Content Disposition form data name ErrorMessage None XbCY DECEMBER 2012 46 BlueCross BlueShield of South Carolina 276 277 Companion Guide Here is an example of a Batch Results Acknowledgement Submission message using the HTTP MIME Multipart envelope method POST core eligibility HTTP 1 1 Host server_host server_port Content Length 244508 Content Type multipart form data boundary XbCY XbCY Content Disposition form data name PayloadT ype X12_999 SubmissionRequest_005010X231A112 XbCY Content Disposition form data name ProcessingMode Batch XbCY Content Disposition form data name Payload D 81d4fae 7dec 11d0 a765 00a0d91 e6fa 6 XbCY Content Disposition form data name PayloadLength 10240
64. c Radioisotope Facility 5W Magnetic Resonance Imaging MRI Facilit 5X Ultrasound Unit 5Y Rehabilitation Inpatient Unit 5Z Rehabilitation Outpatient Services 61 Performed At 6A Reproductive Health Services 6B Skilled Nursing or Other Long Term Care Unit 6C Single Photon Emission Computerized Tomography SPECT Unit 6D Organized Social Work Service Facility 6E Outpatient Social Work Services 6F Emergency Department Social Work Services 6G Sports Medicine Clinic Services 6H Hospital Auxiliary Unit 6l Patient Representative Services 6J Volunteer Services Department 6K Outpatient Surgery Services 6L Organ Tissue Transplant Unit 6M Orthopedic Surgery Facility 6N Occupational Therapy Services 60 Physical Therapy Services 6P Recreational Therapy Services 6Q Respiratory Therapy Services 6R Speech Therapy Services 6S Women s Health Center Services 6U Cardiac Rehabilitation Program Facility 6V Non Invasive Cardiac Assessment Services 6W Emergency Medical Technician 6X Disciplinary Contact 6Y Case Manager 71 Attending Physician 72 Operating Physician 73 Other Physician 74 Corrected Insured 77 Service Location 7C Place of Occurrence 80 Hospital 82 Rendering Provider 84 Subscriber s Employer 85 Billing Provider 87 Pay to Provider 95 Research Institute CK Pharmacist CZ Admitting Surgeon D2 Commercial Insurer DD Assistant Surgeon DJ Consulting Physician DK Ordering Physician DN Referring Pro
65. c cece eee ee eee e eee ee eee ee neta sean esta eee eaeeanees 19 4 5 Password Change Procedures vcccicveeicesstead cijansccccevenecdedcceeseeteaveetcneetsicenegecvirened eens 21 AG Diaku PUR aioa os shee ee ugk a aa a a eee eee een eee 27 4 6 1 Uploading Files Using FTP 2 0 22 cccceeeeeeec eee ee eee cece tenet encase esa eens sansa eases eaeaes 29 4 6 2 Downloading Files Using FTP cceceecece eect cece ee ee eee eae ease eee anes aesaeaeeeeeaeaes 30 4 7 Secure File Transfer Protocol SFTP cscececccseceeeeeeeeeeeceeeeeeeeeeeaeaeeeseseeetenatananaeaes 31 4 3 Connect Direct NOM iseisceience ves aa aaae ds obits a a a a aA a aaa aaa a aAa aaea ina ata 31 AO TO E a a West a eee a a a a E Raa Gale 32 4 10 EDIG Proprietary Claim RESPONSES cscececeeceeeceeeeeceseeeeeeaeeaeaeaeeeseseeetetenananaeaes 32 4 11 Claim Submission Summary Report s ssssessassssssrnrnsrnnrnrrnrnnrnsrnnnnrrnrnnrnsrnrnnrnnnnnnnn 33 4 11 1 Error Claim Summary Report cccccccececeeeeeeeeaeaeaeeeseseeeeeeacaeaeaeeesesenenenesaees 33 4 11 2 Error Claim Summary Report Batch TA1 999 Process FIOW cceeeeeeeeeeeeeees 34 4 11 3 Error Claim Summary Report 271 Batch Pickup Process FIOW s sseeeeeeeeees 35 4 12 Transmission Administrative ProC CUIS cscsccecececececeeeeeeeeeeaeaeaeaesesesesesenenanaeaes 36 4 12 1 Structure REQUIFEMENHS cccccccecececececeeeeeeeeaeauaeeeseseeesesaeaeaeaesesesesenenesaeas 36 412 2 RESPONSE TIMES s
66. cessed HTTP 400 Bad Request error with formatted HTTP headers HTTP 500 Internal Server Error error during processing e Envelope Errors regarding the structure or data included within the body of the SOAP message respective to the definitions set forth in the SOAP fault specifications located at www ws org TR soap12 part1 soapfault Application specific errors are as follows O 000000 0 Success processed successfully Payload ID Required missing Payload ID or did not conform to format User Name Required missing User Name or did not conform to format Password Required missing Password or did not conform to format Payload Required missing Payload or did not conform to format Sender ID Required missing Sender ID or did not conform to format Receiver ID Required missing Receiver ID or did not conform to format CORE Rule Version Required missing CORE Rule Version or did not conform to expected format e Transaction X12 Errors concerning ANSI transaction compliancy will be returned as a SOAP message containing the associated ANSI response data i e TA1 or 999 DECEMBER 2012 52 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 15 5 Submission Retrieval Detailed SOAP WSDL envelope standard for CORE Phase II Connectivity can be found at www cagh org pdf CLEAN501 0 270 v5010 pdf 4 15 5 1 Real time Real time requests sent to the BlueCross BlueShi
67. ction and send a HIPAA compliant X12 datastream preceded by a header The X12 transactions must be enveloped as single transactions i e one ST SE per GS GE per ISA IEA The length of the X12 transaction datastream cannot exceed 32K BlueCross BlueShield of South Carolina corporate policy requires all passwords to be changed every 30 days As of June 1 2011 all Real Time trading partners with non expiring passwords must comply with this policy Here are our guidelines for your user ID and password e Each system user will be prompted to change his or her password every 30 days e User IDs will be revoked when an incorrect password is entered three consecutive times e User IDs will be deleted when not used for 90 or more days e The password length must be eight characters and contain at least one alpha character one numeric character and one of these special characters e Previously used passwords will be stored to prevent reuse of previously used passwords for a minimum of 12 prior generations of the password 4 10 EDIG Proprietary Claim Responses When you transmit electronic claims to the BlueCross BlueShield of South Carolina EDI Gateway the gateway generates responses that advise you of the status of your submission All trading partners will receive the response file It consists of one record for each claim processed by EDIG Also some trading partners will receive two reports the Claims Submission Summary Report and the Error Clai
68. d Command sent successfully The new password you have chosen does not follow the standard password composition definition Please choose a new password 17530 Password entered does not follow password mask rules Password change process is complete Press any key to return to main menu Connected 0 01 39 yri00 fiiszoose1 Fou kaps amt Catue Freeecto 7 DECEMBER 2012 24 BlueCross BlueShield of South Carolina 276 277 Companion Guide 9 If the password you entered is similar to a previous password the system will give you this error and return you to the Main Menu Example You changed the password for user 1GW0001SCQ from 001SCQ to 111SCQ and later tried to re use 001SCQ asa password The system will not accept it You then changed it to 001SCQXX and the system accepted the new password Em x Any Any character Cd Any Any keyboard character Letter board character Letter number or symbol en Alphabetic character ar ee ie L Alphanumeric character A Z a z 0 9 f 1 S E lt gt REDI EDIGATEWAY TEST HyperTerminal Sl x Fle Edt View Cal Trasfer Help Diss 213 ols Please enter your log in user id 1GW8801SC0 Please enter your current password Please enter your new password Please enter your new password again Sanding command to Se your S pad Command sent successfully Your new password is the same as your current passwor
69. d or has been recently used Please choose a new password 17507 New password matches a password previously used Password change process is complete Press any key to return to main menu Connected 0 03 20 rioa fiszooe n 1 SRO Kas fiat iue o DECEMBER 2012 25 BlueCross BlueShield of South Carolina 276 277 Companion Guide Note BlueCross BlueShield of South Carolina corporate policy requires all passwords to be changed every 30 days As of June 1 2011 all Asynchronous and FTP Dial up trading partners must comply with this policy Asynchronous Dial up users will be prompted to provide new passwords when logging in after their old passwords have expired Here are the guidelines for passwords Password length must be six to eight characters Use randomly generated passwords when feasible Avoid any password based on repetition dictionary words letter or number sequences usernames relative or pet names or biographical information e g dates ID numbers ancestor s names or dates Include numbers and symbols in passwords These symbols are allowed amp _ i lt gt Use uppercase and lowercase letters Avoid using the same password for multiple sites or purposes If you cannot remember your password or are experiencing problems with your password please call the BlueCross BlueShield of South Carolina Technology Support Center at 803 736 5980 or 800 868 2505 for assistance
70. dable and Quality Healthcare It is a not for profit alliance of health plans provider networks and associations with a goal to provide a variety of solutions to simplify health care administration 1 3 References 1 3 1 ASC X12 Version 5010A1 Implementation Guides http www wpc edi com 1 3 2 BlueCross BlueShield of South Carolina http www hipaacriticalcenter com UserFiles hipaacritical Documents GPNet 2011_1 2 OManual052012 pdf 1 3 3 CAQH www cagh org benefits php 1 4 Additional Information Submitters must have Internet HTTPS connection capability to submit a 276 request and receive 277 responses The submitter must be associated with at least one provider in the BlueCross BlueShield of South Carolina provider database Both real time and batch 276 inquiries are supported This system supports inquiries for BlueCross BlueShield of South Carolina members only DECEMBER 2012 7 BlueCross BlueShield of South Carolina 276 277 Companion Guide 2 GETTING STARTED 2 1 Working with BlueCross BlueShield of South Carolina Providers billing services and clearinghouses interested in submitting 276 inquiries and receiving 277 responses via BlueCross BlueShield of South Carolina should contact BlueCross BlueShield of South Carolina by visiting www hipaacriticalcenter com and clicking on Contact Us on the top right 2 2 Trading Partner Registration Enrollment with the EDI Gateway requires prospective trading partners to compl
71. de 4 12 Transmission Administrative Procedures This table lists protocol and transfer methods for each connectivity option Connectivity Protocol Transfer Method SFTP SSH2 SFTP software negotiates encryption such as DES 3DES CAST 128 VPN VPN over TCP IP FTP NDM IP NDM Proprietary Dial up REDI Proprietary transfer via X Y or Z modem Dial up FTP Proprietary FTP IP TCPIP Proprietary IP connection via VPN or AGNS This table lists connectivity options available for certain transactions Transaction Available Connectivity Types X12N 276 Dial up SFTP NDM VPN TCPIP 4 12 1 Structure Requirements Real time 276 requests are limited to one inquiry per patient per transaction Batch 276 requests are limited to 99 ST SE groupings per transaction Each batch inquiry must be in its own ST SE 4 12 2 Response Times A response TA1 999 reject or 277 to real time inquiries will be provided within 20 seconds A response to the batch inquiry will be provided by 7 a m ET the following day Batch requests submitted after 9 p m ET will be available by 7 a m ET two days following submission Due to requirements from the Blue Cross and Blue Shield Association transactions that must be sent to other Blue Cross and Blue Shield Plans for processing may take up to 45 seconds to generate a response 4 13 Re Transmission Procedures If a real time response message is not received within th
72. directors managing employees Providers or Suppliers is charged with a criminal offense relating to one or more government contracts or government subcontracts or to federal health care programs as defined in Social Security Act 1128B f listed by a federal agency as debarred proposed for debarment or suspended or otherwise excluded from federal program participation including exclusion from participation in a federal health care program as defined in the Social Security Act 1128B f lil OBLIGATIONS OF THE PARTIES 3 1 Mutual Obligations The mutual obligations of BlueCross BlueShield of South Carolina and Trading Partner include the following a Transmission Format All standard transactions as defined by Social Security Act 1173 a and the Transaction Rules conducted between BlueCross BlueShield of South Carolina and Trading Partner will be conducted electronically and will only use code sets data elements and formats specified by the Transaction Rules and the then current version of the BlueCross BlueShield of South Carolina Supplemental Implementation Guides The BlueCross BlueShield of South Carolina Supplemental Implementation Guides and any updates or amendments thereto may be accessed at www SouthCarolinaBlues com and are incorporated herein by reference This section will automatically amend to comply with any DECEMBER 2012 84 BlueCross BlueShield of South Carolina 276 277 Companion Guide final regulation or am
73. dually Identifiable Health Information 45 C F R Parts 160 and 164 the Privacy Act of 1974 5 U S C 552A or other applicable state and federal statutes and regulations including statutes and regulations protecting the privacy of general medical mental health and substance abuse records collectively Privacy Statutes and Regulations 1 4 Covered Individual means an Individual who is eligible for payment of certain services or supplies rendered or sold to the Individual or to the Individual s eligible dependents under the terms conditions limitations and exclusions of a health benefit program issued or administered by BlueCross BlueShield of South Carolina or a health benefit program issued or administered by another Payor DECEMBER 2012 93 BlueCross BlueShield of South Carolina 276 277 Companion Guide 1 5 1 6 1 7 1 8 1 9 Data Transmission means automated transfer or exchange of data pursuant to the terms and conditions of this Agreement between BlueCross BlueShield of South Carolina and Trading Partner or Business Associate by means of their respective Operating Systems which are compatible for that purpose and includes without limitation Electronic Data Interchange EDI Electronic Remittance Advice ERA and Electronic Media Claims EMC transmissions Electronic Data Interchange EDI means the automated exchange of business documents from application to application Electronic Med
74. e 60 second response period the submitter s system should send a duplicate transaction no sooner than 90 seconds after the original attempt was sent If no real time response is received after the second attempt the submitter s system should submit no more than five duplicate transactions within the next 15 minutes If additional attempts result in the same timeout termination the submitter s system must notify the submitter to contact the receiver directly to determine if system availability problems exist or if there are known Internet traffic constraints causing the delay DECEMBER 2012 36 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 14 Communication Protocols BlueCross BlueShield of South Carolina supports standard HTTP MIME messages The MIME format used must be that of multipart form data Responses to transactions sent in this manner will also be returned as multipart form data 4 14 1 Header Requirements The HTTP header requirements for MIME transactions are as follows e UserName eight character max e Processing Mode o Accepted values are Real time for real time inquiries Batch for batch inquiries either submission or pickup e Password 50 character max Payload Type o Accepted values are X12_276 Request_005010X212A1 e Real time and Batch Submission X12_005010 Request_Batch_Results_277 e Batch Results Retrieval X12_005010 Request_BatchSubmissionMixed e Mixed Batch
75. e and simple data elements 5 Any other information tied directly to a loop segment composite or simple data element pertinent to trading electronically with BlueCross BlueShield of South Carolina and its subsidiaries health plans In addition to the row for each segment one or more additional rows are used to describe BlueCross BlueShield of South Carolina and its subsidiaries health plans usage for composite and simple data elements and for any other information DECEMBER 2012 67 BlueCross BlueShield of South Carolina 276 277 Companion Guide Page Loop ID Reference Name Codes Notes Comments 41 2100A NM1 Payer Name 42 2100A NM108 Identification Code Qualifier This element must equal PI 42 2100A NM108 Identification Code Qualifier PI Payer Identification 42 2100A NM109 Identification Code The following codes are accepted 42 2100A NM109 Identification Code 38520 BlueCross BlueShield of South Carolina 77828 Companion Life Insurance Company 95741 BlueChoice HealthPlan 76031 Florida Combined Life DECEMBER 2012 68 BlueCross BlueShield of South Carolina 276 277 Companion Guide Page 49 Loop ID 2100C Reference NM1 Name Provider Name Codes Notes Comments 51 2100C NM108 Identification Code Qualifier All providers eligible under the Centers for Medicare amp Medicaid Services CMS guidelines to receive a National Provider ID NPI number
76. e are identified in the column at right 1 To apply for a new Trading Partner ID check New Trading Partner ID 2 To change Trading Partner information check Change 3 To cancel your enrollment check Cancel Trading Partner Name Enter the name of the entity that will be submitting receiving electronic transactions with BlueCross BlueShield of South Carolina EDIG Trading Partner ID EDIG assigns the Trading Partner ID to identify trading partners in our system Federal Tax ID Enter the trading partner s federal tax identification number Type of Business Line of Business Select the type of primary business the trading partner conducts If you check Other indicate the type of business on the line provided Check one box per enrollment form indicating if transactions are BlueCross BlueShield of South Carolina Commercial or PGBA Start Date Indicate in mm dd ccyy format the date the trading partner plans to begin transaction testing with BlueCross BlueShield of South Carolina EDIG End Date If you are using this form to cancel an account indicate in mm dd ccyy format the date the trading partner intends to terminate its trading partner account Compression If you wish to download your files in a compressed format check PKZIP or UNIX If not check No Compression Protocol Check the preferred communication method If you select Secure FTP or VPN complete and
77. e not authorized in this Agreement Trading Partner will safeguard BlueCross BlueShield of South Carolina s Proprietary Information against unauthorized disclosure and use c Notice of Unauthorized Disclosures and Uses Trading Partner will promptly notify BlueCross BlueShield of South Carolina of any unlawful or unauthorized use or disclosure of Confidential Health Information or BlueCross BlueShield of South Carolina s Proprietary Information that comes to Trading Partner s attention and will cooperate with BlueCross BlueShield of South Carolina in the event that any litigation arises concerning the unlawful or unauthorized disclosure or use of Confidential Health Information or BlueCross BlueShield of South Carolina s Proprietary Information 5 2 Operating Systems Security Each Party will develop implement and maintain measures necessary to ensure the security of each Party s own Operating System and each Party s records relating to its Operating System Each Party will document and keep current its security measures Each Party s security measures will include at a minimum the requirements and implementation features set forth in Social Security Act 1173 d and all applicable HHS implementing regulations VI RECORDS RETENTION AND AUDIT 6 1 Records Retention Trading Partner will require Providers and Suppliers to maintain complete accurate and unaltered copies of all Source Documents from all Data Transmissions Trading P
78. e term of this Agreement Each Party will take necessary and reasonable steps to ensure that its Trade Data Log constitutes a complete accurate and unaltered record of each Data Transmission between the Parties Each Party will retain Data Transmission records for not less than twenty four 24 month s following the date of a Data Transmission Each Party will maintain its Trade Data Log on computer media or other suitable means that permit timely retrieval and presentation in readable form DECEMBER 2012 98 BlueCross BlueShield of South Carolina 276 277 Companion Guide 6 3 6 4 Right to Audit BlueCross BlueShield of South Carolina will have the right to audit relevant Trading Partner s business records Trading Partner s Trade Data Log Trading Partner s Operating System and Business Associate as BlueCross BlueShield of South Carolina in its sole discretion deems necessary to ensure compliance with this Agreement Government Requests for Information Trading Partner will notify BlueCross BlueShield of South Carolina immediately upon Trading Partner s receipt of any request from a government authority for information or documents relating to this Agreement except to the extent such notification is prohibited by law Vil REPRESENTATIONS AND WARRANTIES 7 1 7 2 7 3 7 4 Government Programs Trading Partner represents and warrants that a Neither the United States government any state or local government nor any prime
79. eld of South Carolina submitted to this type of URL https services bcbssc con Where ENV Environment UNIT SYST QUAL PROD REG Region Specific host region if needed or default value if not SVCNAME Name of the Web service to be called 1 for MIME and SOAP em must be All payloads X12 data must be embedded using the Inline method CDATA element for real time SOAP transactions 4 15 5 2 Batch Batch requests sent to the BlueCross BlueShield of South Carolina system must be submitted to this type of URL https services bcbssc com ENV REG Where ENV Environment UNIT SYST QUAL PROD REG Region Specific host region if needed or default value if not SVCNAME Name of the Web service to be called 1 for MIME and SOAP All batch payloads must be sent utilizing SOAP Message Transmission Optimization Mechanism MTOM encapsulated MIME part For more information please see www w3 org TR soap12 mtom 4 15 5 3 SOAP Header The WS Security username and password token shown in 4 15 6 in gray background is added to the SOAP Header by the platform on which SOAP is run The SOAP platform s Web Services Security Extensions may be configured to insert these tokens DECEMBER 2012 53 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 15 4 SOAP Sample Fault Here is an example of a SOAP fault request lt soap Envelope xmins soap http schemas xmlsoap org soap envelope xmIns bcbs http
80. endment to a final regulation adopted by HHS concerning the subject matter of this Section upon the effective date of the final regulation or amendment b Testing Prior to the initial Data Transmission each Party will test and cooperate with the other Party in testing the connectivity and interaction of the Parties Operating Systems to ensure the accuracy timeliness completeness and confidentiality of each Data Transmission c Data Transmission Accuracy The Parties will take reasonable care to ensure that Data Transmissions are timely complete accurate and secure Each Party will take reasonable precautions in accordance with Article V of this Agreement to prevent unauthorized access to the other Party s Operating System Data Transmissions or the contents of an Envelope transmitted to or from either Party d Retransmission of Lost or Indecipherable Transmissions A Party will retransmit the original transmission within three 3 business day s of its discovery that a Data Transmission is a lost or indecipherable Transmission e Equipment Cost Each Party will obtain and maintain at its own expense its own Operating System necessary for timely complete accurate and secure Data Transmission pursuant to this Agreement Each Party will pay its own costs related to Data Transmission under this Agreement including without limitation charges for the Party s own Operating System equipment software and services maintaining an e
81. er When the response file is available listed in your Mailbox return to the Main Menu and proceed to the Download option DECEMBER 2012 17 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 3 4 Download a Response To download a response file 1 Type 1 or D from the Main Menu and press ENTER 2 You will be prompted to choose a modem protocol Figure 10 gt gt gt gt DOWNLOAD A FILE lt lt lt lt 4 Jelect Protocol 2 for Kermit x for XMODEM for YMODBM BATCH for ZMODEM to QUIT Figure 10 Download Protocol Selection Screen a If you select Z Zmodem K Kermit or Y Ymodem the system will ask if you wish to download all files in the mailbox If you choose Yes press Y all available files will begin downloading If you do not want to download all of the files choose No press N and the system will display the list of available files as shown in step 3 b If you select X the Xmodem protocol the file list will display immediately 3 From the list of available files Figure 11 enter the number associated with the desired file to begin the download and press ENTER See the List Files in Mailbox section for information on deciphering the files listed in your mailbox REDI EDIGATEWAY PRODUCTION HyperTerminal OF x File Edit View Call Transfer Help mailbox contains the following files Filename T i Date Time RPTOOO56 RPTOOQO59 RPT 1200054
82. ervice procedure descriptions applicable charges for the services rendered the Provider s or Supplier s name and or identification number and signature 1 19 Supplier means a person or organization that is a customer of Trading Partner and is engaged in the business of selling or leasing durable medical equipment or supplies to Covered Individuals 1 20 Trade Data Log means the complete written summary of Data and Data Transmissions exchanged between the Parties over the period of time this Agreement is in effect and includes without limitation sender and receiver information and transmission date time and general nature ll TERM AND TERMINATION 2 1 Term of Agreement This Agreement will remain in effect for an initial period of three 3 year s from the Effective Date and will automatically renew for successive periods of three 3 year s unless terminated pursuant to Section 2 2 or Section 2 3 2 2 Voluntary Termination Either Party may terminate this Agreement upon one hundred twenty 120 day s prior written notice to the other Party 2 3 Termination for Cause BlueCross BlueShield of South Carolina will have the unilateral right to terminate this Agreement immediately by providing Trading Partner with written notice of termination in the event of i a breach by Trading Partner of any section of Article V or of Article VII of this Agreement or ii Trading Partner any of its related business entities or any of its officers
83. ete and submit the BlueCross BlueShield of South Carolina EDIG Trading Partner Enrollment Form and the Trading Partner Agreement The purpose of the BlueCross BlueShield of South Carolina EDIG Trading Partner Enrollment Form is to enroll providers software vendors clearinghouses and billing services as trading partners and recipients of electronic data It is important you follow these instructions and complete all the required information We will return incomplete forms to the applicant which could delay the enrollment process 2 3 Testing Transactions These vendors have successfully tested and implemented their HIPAA version 5010 276 277 X12N 276 Health Care Claim Status Request transactions with us Company Contact Information Athena Health 888 652 8200 Emdeon 877 363 3666 MBA Technologies 828 233 0001 McKesson 800 806 5730 MedData 800 877 8577 Med Vantage 415 814 7100 Passport Health 888 651 5657 RealMed 877 723 5633 Recondo Technology 888 732 6672 Tera Health Inc MPV 866 930 1230 ViaTrack 800 426 3385 DECEMBER 2012 BlueCross BlueShield of South Carolina 276 277 Companion Guide 3 TESTING WITH THE PAYER There are fewer problems with trading partner exchange of electronic transactions in the production environment when you conduct testing EDI Gateway requires trading partners test every transaction for every payer prior to approval for production status This testing includes security validation connectivity X12 TR3 ed
84. fied search pattern Press RETURN to input new search pattern or q to quit If there are more than 15 files in the list the system will pause and scroll the listing All files in your mailbox are presented in a similar format the 8 byte download file name with a 3 byte extension followed by a file description This table shows examples and explanations of files that you can download File Description Type Sequence Number ZIP or Type fro pate orra IS Control Number OARA EAEOI eal at EEOAE OEE oO Pos 1 2 3 4 X 1 2 0 0 0 0 1 X 1 2 P 0 1 2 5 I1 S A C T R L 0 1 0 0 0 amp ix 1 2 0 ojolo0 2 x 1 2 P0125 1 S A c T R L o 1 0l 00 ZZ R S P o 0o 0 0 3 R s P P 0 1 2 5 1 S A cC T R Lj o 1j00 0 RI P T 0 0 0 0 4 IR P T P 0 1 2 5 1 S A C T R L 0 1 0 0 0 Py TIN Vi0 0 0 0 1 1 N Vi U 0 1 2 5 B x120 ojojo x2 Pos s a c T R L o1 0of0 X 1 2 0 0 0 0 2 X 1 2 P 0 1 2 5 1 S A C T R L 0 1 0 0 0 M S G 0 0 001 MIS G U X 1 2 0 0 0 0 1 Z I P B C B S S C This information describes the file segments Segment Position Description Type 1 3 File types are identified using these 3 byte segments RSP EDIG proprietary claim responses RPT EDIG proprietary claim reports INV Invalid file response MSG Informational messages X12 X12 responses TA1 999 Sequence 4 8 EDIG generated sequential number for each file sent to a mailbox Number 9 Period ZIP
85. gn or delegate any of its rights or obligations hereunder to any of its subsidiaries affiliates or successor companies Otherwise neither Party may assign its rights or delegate its obligations under this Agreement without the prior written consent of the other Party which consent will not be unreasonably withheld or delayed 9 6 Relationship of BlueCross BlueShield of South Carolina to the Blue Cross and Blue Shield Association This Agreement constitutes a contract between Trading Partner and BlueCross BlueShield of South Carolina BlueCross BlueShield of South Carolina is an independent corporation operating under a license with the Blue Cross and Blue Shield Association Association an association of independent Blue Cross and Blue Shield Plans permitting BlueCross BlueShield of South Carolina to use the BlueCross and BlueShield service marks in South Carolina BlueCross BlueShield of South Carolina is not contracting as the agent of the Association Trading Partner has not entered into this Agreement based upon DECEMBER 2012 90 BlueCross BlueShield of South Carolina 276 277 Companion Guide representations by any person other than BlueCross BlueShield of South Carolina and no person entity or organization other than BlueCross BlueShield of South Carolina will be held accountable or liable to Trading Partner for any of BlueCross BlueShield of South Carolina s obligations to Trading Partner under this Agreement 9 7
86. gures 3 and 4 let you dial GPNet and see the status of your call Complete these steps to make your connection a If the Phone number for GPNet and D REDI EDIGATEWAY PRODUCTION Your location are correct Figure 3 ee eee ae o Mod click Dial Notes Your location New Location 7 Dialing Properties e f you need to correct the telephone Calling card None Direct Dial number modem setting or connection icon click the Modify button Click the Dialing Properties button only if you need to correct information about your telephone settings e f you have to dial 9 for an outside line make sure a 9 is displayed in front of the phone number If not go to Modify and make appropriate changes Cancel Figure 3 Connect Message Box 2 Click on Dial Now The Connect message box will change to display Status information After dialing completes you are connected to the GPNet Gateway Figure 4 FPA REDI EDIGATEWAY PRODUCTION SA g 799 6147 SupraFAXModem 288 336 Status Dialing Dal ov Figure 4 Connect Message Box DECEMBER 2012 13 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 3 Log In and User Validation Upon connecting to the GPNet system via your communications program the system will display a banner and prompt for the user ID Figure 5 REDI EDIGATEWAY PRODUCTION HyperTerminal _ ot x File Edit View Call Transfer Help Ols el
87. h Carolina cccccecece eee ee eee ee eeeeeeneeeenaeneeeeneeeees 7 13 3 CAQH EA T A E A E 7 LA Additi hnalliformati oN siias oe a a a a e a E N 7 2 GETTING STARTED aiding aaa nai a AAA E DTE E a EAA 8 2 1 Working with BlueCross BlueShield of South Carolina ssssssssssssssssssssnunnnurnrurnnnnnnennnee 8 2 2 Trading Partner R gistratio N s ices inaire anaa nA a aKa E Ta E 8 23 Testing Transact ON Sae a Deus aE a a E a aa dest ud a a aa aa teat eerie 8 3 TESTING WITH THE PAY R r aa a raaa a e a r e a aT A A Ea SE T ana a ta Naa 9 3 4 Payer Testing oree an clas e a E a A a ved aves a aer A A EAE a EAN 9 3 2 Transition from Test to Production Status ccec cece cece e eect eee e eens ease eee eaeeaeeeeaenannes 9 4 CONNECTIVITY COMMUNICATIONS cccececeececececececacacecaeeeeeeeseeeeeseseeseetatanananaeaenenes 10 4 1 Dialup RED riaan aaia te aaa a a a a A fees Ton ode d Seay eats saab stave ta es A a Ys aaa 12 4 2 Server Connection Using Asynchronous Dial Up ccee eee eee cece eee ee eee eee eaeeaeeeeaeeaeees 13 4 3 Log In and User Validation 0 ccccececee cece cece cece ee ee ee ee ee ee ee eee nee seen eeneeeeeeees 14 4 3 AMESSABES i 2 hve se se steed A T ade dee oa ru an sve A TTET 15 43 2 Main MGnU rrian eataa aaa aaa aaa aan aaa adota ranie 16 43 3 UplOad a S E E E E E A AEN 17 43 A Download a RESPONSES ereraa nN E AEE EEE AA E ETN R 18 4 4 List Files in Mailbox for X12 TransactiOns c
88. health care to an Individual Individual means a person whose claims for services or supplies may be eligible to be paid under the terms of an applicable governmental or private program for which BlueCross BlueShield of South Carolina processes or administers claims and specifically includes without limitation Medicare Eligible Individuals Medicaid Eligible Individuals and Covered Individuals BlueCross BlueShield of South Carolina and Trading Partner acknowledge and agree that claim payments made according to this Agreement will be made directly to Trading Partner or Business Associate on behalf of the Individual Individually Identifiable Health Information means any Health Information including demographic information collected from an Individual that is created or received by a Provider health plan employer or health care clearinghouse and either i identifies an Individual or ii creates a reasonable basis to believe the information can be used to identify the Individual Operating System means the equipment software and trained personnel necessary for a successful Data Transmission Payor means a business organization that provides benefit payments for certain services or supplies rendered or sold to Covered Individuals or their eligible dependents under the terms conditions limitations and exclusions of a health benefit program issued or administered by the Payor Proprietary Information means information used or created by BlueCross
89. ia Claims EMC means automated methods of submitting claims for payment of medical services or supplies rendered or sold by a Provider or Supplier to an Individual Electronic Remittance Advice ERA means a document containing information pertaining to the disposition of a specific claim for payment of services or supplies rendered to an Individual that a Provider or Supplier files with BlueCross BlueShield of South Carolina on the Individual s behalf The documents include without limitation information such as the Provider or Supplier name and address Individual s name date of service amount billed amount paid whether the claim is approved or denied and if denied the reason for the denial Envelope means a control structure in a format mutually agreeable to BlueCross BlueShield of South Carolina and Trading Partner for the electronic interchange of one or more encoded Data Transmissions between BlueCross BlueShield of South Carolina and Trading Partner or Business Associate Health Information means any information whether oral or recorded in any form or medium that i is created or received by a Provider health plan public health authority employer life insurer school university or health care clearinghouse and ii relates to the past present or future physical or mental health or condition of an Individual the provision of health care to an Individual or the past present or future payment for the provision of
90. ian QK Managed Care QL Chiropractor QN Dentist QO Doctor of Osteopathy QS Podiatrist QV Group Practice QY Medical Doctor RC Receiving Location RW Rural Health Clinic S4 Skilled Nursing Facility SEP Secondary Payer SJ Service Provider SU Supplier Manufacturer T4 Transfer Point TL Testing Laboratory DECEMBER 2012 62 BlueCross BlueShield of South Carolina 276 277 Companion Guide TT TQ Third Party Reviewing Organization TPO Transfer To TTP Tertiary Payer UH TU Third Party Repricing Organization TPO Nursing Home X3 Utilization Management Organization X5 X4 Spouse Durable Medical Equipment Supplier ZZ Mutually Defined DECEMBER 2012 63 BlueCross BlueShield of South Carolina 276 277 Companion Guide 8 ACKNOWLEDGMENTS 8 1 EDIG Acknowledgment and Response Transactions Matrix This table lists acknowledgment and response transactions returned to the trading partner when EDI Gateway receives HIPAA X12 transactions Transaction Interchange TR3 Edit Results Payer SIG Payer Appl Edit Acknowledgement Edit Results Results 276 TA1 If errors 999 X12 TR3 edit 277 277 results is returned If not edit results are not returned 276 TA1 9997 277 277 Batch of one The most simple singular request is contained in the ST SE for a transaction Batch of many All other record groupings t X12 Tech
91. ick on OK Figure 1 Note If you are unable to locate HyperTerminal under Accessories look in the Communications option If unable to find that option then look up Installing Windows Components in Windows Help 2 The Connect To message box Figure 2 is where you enter the GPNet phone number and verify your country code area code and modem Complete these steps a For Country region select United States of America 1 if it does not initially display in the field b In the Area code field Enter 803 c In the Phone number field Enter 788 6147 for production or 788 3362 for test d In the Connect using field you should already see a description of your modem Verify that it is correct or use the menu to select the correct modem e Click OK DECEMBER 2012 Connection Description 2x ale New Connection Enter a name and choose an icon for the connection Name REDI EDIGATEWAY PRODUCTION Cancel Figure 1 Connection Description Box Connect To 24x D REDI EDIGATEWAY PRODUCTION Enter details for the phone number that you want to dial Country region United States of America Area code jo o o Phone number 7886147 0 Connect using SupraFAXModem 288i 336 Cancel Figure 2 Connect To Message Box 12 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 2 Server Connection Using Asynchronous Dial up 1 The Connect message boxes Fi
92. ing Partner uses to receive transmit store or process data or Data Transmissions or perform related activities as though the act failure or omission were that of Trading Partner Notices Regarding Business Associates Trading Partner will prior to commencement of Business Associate s services in connection with this Agreement submit a complete executed Trading Partner Business Associate Authorization Rider Business Associate Rider designating each Business Associate authorized to send or receive Data or Data Transmissions to or from BlueCross BlueShield of South Carolina on Trading Partner s behalf Trading Partner will notify BlueCross BlueShield of South Carolina at least fourteen 14 days prior to the date of any material change to the information contained in the Business Associate Rider The Business Associate Rider will be effective and incorporated DECEMBER 2012 97 BlueCross BlueShield of South Carolina 276 277 Companion Guide into this Agreement on the date it is received by BlueCross BlueShield of South Carolina Trading Partner s designation of any Business Associate for purposes of performing services in connection with this Agreement is subject to BlueCross BlueShield of South Carolina s approval BlueCross BlueShield of South Carolina will not unreasonably withhold approval of Trading Partner s designated Business Associates V CONFIDENTIALITY AND SECURITY 5 1 5 2 Data Security Trading Partner will m
93. ing disclosure pursuant to the Foreign Corrupt Practices Act as amended 15 U S C 78dd 1 78dd 2 Legal Compliance Trading Partner will use reasonable efforts to comply and to cause Trading Partner s directors officers employees and Business Associate to comply in all material respects with all requirements of all laws pertaining to government contracts or government subcontracts the violation of which may result in Trading Partner or its directors officers or employees or other persons being charged with a criminal offense For purposes of this Section 7 2 laws mean all applicable statutes laws rules regulations permits decrees injunctions judgments orders rulings determinations writs and awards Warranties Regarding Business Associates Trading Partner warrants that Business Associate will make no changes in the Data content of Data Transmissions or the contents of an Envelope Trading Partner further warrants that Trading Partner will advise Business Associate of this Agreement and that Business Associate will comply in all respects with the terms of this Agreement Notice of Violations Trading Partner will notify BlueCross BlueShield of South Carolina in writing within three 3 business days of obtaining knowledge of any criminal investigation indictment information or charge by any governmental entity or communications indicating that the same may be contemplated related to Trading Partner or any of T
94. is process The trading partner should correct transactions reported as errors and resubmit them Acknowledgment Response Transactions Trading partners must demonstrate the ability to receive acknowledgment and response transactions from EDIG EDIG expects trading partners will also implement balancing or reconciliation processes and report transmission discrepancies to us immediately Results Analysis EDIG and the trading partner will review acknowledgment and response transactions for consistency with the predefined expected results 3 1 Payer Testing Depending on the line of business and transaction the payer may require additional testing If so EDIG Operations will inform the trading partner when test plans are discussed 3 2 Transition from Test to Production Status When test results have satisfied the test plan and the Trading Partner Agreement has been executed we will change the trading partner s submission status from test to production At this time the trading partner can begin to send production transaction data to EDIG DECEMBER 2012 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 CONNECTIVITY COMMUNICATIONS BlueCross BlueShield of South Carolina provides access to a number of internal processes via Web services Partners are issued an identifier known as the Consumer ID by BlueCross BlueShield of South Carolina during project initiation The Consumer ID is used for tw
95. its and front end payer edits when available in the test environment These tests must be performed for each different transaction type that a trading partner is approved to submit to EDIG Test Plan EDIG and the trading partner will agree to a predefined set of test data with expected results The matrix will vary by transaction and trading partner Also we will develop a plan for a test to production transition that considers volume testing and transaction acceptance ratios Connectivity You will find EDIG supported connectivity protocols in the Connectivity topic in this section This first level of testing is complete when the trading partner has successfully sent to and received from EDIG a test file via one of the EDIG supported connectivity options Security EDIG will validate approved trading partners are submitting transactions allowed per our enrollment applications Data Integrity When HIPAA X12 transactions are transmitted data integrity is determined by X12 TR3 edits results performed by EDIG s TR3 editor Testing cannot progress until a trading partner s data receives no TR3 edit errors EDIG expects there may be an occasional situation in which a trading partner s TR3 edit interpretation differs from our interpretation We will work with our trading partner to resolve such differences on an individual basis EDIG returns transmission acknowledgment and edit results response transactions from th
96. l Up Networking Window 3 The Make New Connection wizard Make Now Connection Er will open Figure 14 In the first field type GPNet Confirm that the appropriate modem for your system is chosen in the second field and then click Next Type a name for the computer you are dialing GPNef g Standard Modem x Configure Ee Figure 14 Make New Connection Wizard 1 DECEMBER 2012 27 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 On the next window Figure 15 type Make Now Connection a 803 in the Area code field and 788 6705 Tape th ores og thet comptar yod arani tacat for production or 788 3724 for test in the Telephone number field Click Next Area code Telephone number fe03 z 788 6709 Country code United States of America 1 pez Figure 15 Make New Connection Wizard 2 5 The final wizard window will display Kae adltealleacna x Figure 16 Click Finish to save and eee create the shortcut for this new EEN connection Click Finish to save it in your Dial Up Networking folder Double click it to connect To edit this connection later click it click the File menu and then click Properties E Figure 16 Make New Connection Wizard 3 6 Go back to your Dial Up Networking F DialUp Networking MEE m Fie Edit View Connections Help folder Figure 17 and double click the aaneen A 3 OLS slee a xa eael new GP
97. l inquiries 73 2210D REF Service Line Item BlueCross BlueShield of Identification South Carolina does not support line level inquiries 74 2210D DTP Service Line Date BlueCross BlueShield of South Carolina does not support line level inquiries DECEMBER 2012 72 BlueCross BlueShield of South Carolina 276 277 Companion Guide Page Loop ID Reference Name Codes Notes Comments 89 2200E AMT Claim Submitted Charges This segment is not required 89 2200E AMT02 Monetary Amount If the request does not specify a claim amount the value of this field may be a single 0 zero to return all claims If an amount is submitted and it matches a claim or claims found within the date range submitted for the provider specified all claims matching that dollar amount will be returned If no claims match that dollar amount all claims for the provider within the date range submitted will be returned 90 2200E DTP Claim Service Date This segment is required even when the request does not depend upon the service date 91 2200E DTP03 Date Time Period To request information on claims regardless of date of service this field may be 20000101 CCYYMMDD where CCYYMMDD equals the request date This element is required when the subscriber is the patient DECEMBER 2012 73 BlueCross BlueShield of South Caroli
98. le If any provision of this Agreement is held or declared to be illegal invalid or unenforceable the remainder of the Agreement will continue in full force and effect as though the illegal invalid or unenforceable provision had not been contained in the Agreement 9 11 Entire Agreement This Agreement together with its Exhibits and any applicable Riders and Amendments constitutes the entire understanding between the Parties with respect to the subject matter of this Agreement and supersedes and cancels all previous written or oral understandings agreements negotiations commitments and any other writing and communication by or between the Parties on this specific subject matter In the event of any inconsistency between any provision of this Agreement and any provision of a Rider to this Agreement the provision of this Agreement controls 9 12 Automatic Amendment for Regulatory Compliance This Agreement will automatically amend to comply with any final regulation or amendment to a final regulation adopted by HHS concerning the subject matter of this Agreement upon the effective date of the final regulation or amendment 9 13 Survival The provisions of Sections 3 1 d and 3 2 Article V Sections 6 1 and 6 2 and Article VIII will survive termination of this Agreement DECEMBER 2012 91 BlueCross BlueShield of South Carolina 276 277 Companion Guide SIGNATURES The Parties will be bound by all the terms provisions Agreed to BLUE CRO
99. lectronic mailbox connection time terminals connections telephones modems and applicable minimum use charges Each Party will be responsible for its own expenses incurred for translating formatting and sending or receiving communications over the electronic network to any electronic mailbox of the other Party f Backup Files Each Party will maintain adequate backup files electronic tapes or other sufficient means to recreate a Data Transmission for at least six 6 years from the Data Transmission s creation date Such backup files tapes or other sufficient means will be subject to the terms of Article V of this Agreement to the same extent as the original Data Transmission Sc Data and Data Transmission Security BlueCross BlueShield of South Carolina and Trading Partner will employ security measures necessary to protect Data and Data Transmissions between them including authentication encryption password use or other security measures in compliance with Social Security Act 1173 d and any HHS implementing regulations or guidelines and as set forth in Article V of this Agreement Unless BlueCross BlueShield of South Carolina and Trading Partner agree otherwise the recipient of data or Data Transmission will use at least the same level of protection for any subsequent transmission as was used for the original transmission 3 lt Security Access Codes The Security Access Codes that BlueCross BlueShield of South Carolin
100. liers of this Agreement and that Providers and Suppliers will comply in all respects with the terms of this Agreement 7 4 Notice of Violations Trading Partner will notify BlueCross BlueShield of South Carolina in writing within three 3 business days of obtaining knowledge of any criminal investigation indictment information or charge by any governmental entity or communications indicating that the same may be contemplated related to Trading Partner or any of Trading Partner s directors officers employees vendors agents Providers or Suppliers DECEMBER 2012 88 BlueCross BlueShield of South Carolina 276 277 Companion Guide Vill INDEMNIFICATION 8 1 Indemnification of BlueCross BlueShield of South Carolina Trading Partner will indemnify defend and hold BlueCross BlueShield of South Carolina harmless from any and all claims actions damages liabilities costs or expenses including without limitation reasonable attorneys fees arising out of any act or omission of Trading Partner Providers Suppliers or their respective employees subcontractors or other persons in the performance of this Agreement BlueCross BlueShield of South Carolina will have the option at its sole discretion to employ attorneys to defend any such claim action or proceeding arising out of these acts or omissions the costs and expenses of which will be Trading Partner s responsibility BlueCross BlueShield of South Carolina will provide Trading Partne
101. lina Supplemental Implementation Guides The BlueCross BlueShield of South Carolina Supplemental Implementation Guides and DECEMBER 2012 95 BlueCross BlueShield of South Carolina 276 277 Companion Guide any updates or amendments thereto may be accessed at www SouthCarolinaBlues com and are incorporated herein by reference This section will automatically amend to comply with any final regulation or amendment to a final regulation adopted by HHS concerning the subject matter of this Section upon the effective date of the final regulation or amendment Testing Prior to the initial Data Transmission each Party will test and cooperate with the other Party in testing each Party s Operating System to ensure the accuracy timeliness completeness and confidentiality of each Data Transmission Data Transmission Accuracy The Parties will take reasonable care to ensure that Data Transmissions are timely complete accurate and secure Each Party will take reasonable precautions in accordance with Article V of this Agreement to prevent unauthorized access to the other Party s Operating System Data Transmissions or the contents of an Envelope transmitted to or from either Party Retransmission of Lost or Indecipherable Transmissions A Party will retransmit the original transmission within three 3 business day s of its discovery that a Data Transmission is a lost or indecipherable Transmission Equipment Cost Each Party will obtain and maintain
102. lue Shield Association Association an association of independent Blue Cross and Blue Shield Plans permitting BlueCross BlueShield of South Carolina to use the BlueCross and BlueShield service marks in South Carolina BlueCross BlueShield of South Carolina is not contracting as the agent of the Association Trading Partner has not entered into this Agreement based upon representations by any person other than BlueCross BlueShield of South Carolina and no person entity or organization other than BlueCross BlueShield of South Carolina will be held accountable or liable to Trading Partner for any of BlueCross BlueShield of South Carolina s obligations to Trading Partner under this Agreement 9 7 Force Majeure Each Party will be excused from performance for any period of time during this Agreement that it is prevented from performing any obligation or service in whole or in part as a result of causes beyond its reasonable control and without its fault or negligence Such acts include without limitation acts of God strikes lockouts riots acts of war epidemics governmental regulations imposed after the fact fire communication line failures power failures earthquakes floods or other natural disasters Delays in DECEMBER 2012 101 BlueCross BlueShield of South Carolina 276 277 Companion Guide 9 8 9 9 9 10 9 11 9 12 9 13 performance because of the occurrence of such events will automatically extend due dates for a
103. m Summary Report The Claims Submission Summary Report is a listing of what BlueCross BlueShield of South Carolina EDI Gateway actually received from you and it indicates whether those claims passed the first set of front end edits The Error Claims Summary Report identifies errors on rejected claims so that you can correct and resubmit your claims as soon as possible DECEMBER 2012 32 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 11 Claim Submission Summary Report The Claims Submission Summary Report shows all claims received from a trading partner and whether they were accepted or rejected This report may contain multiple pages The table following the sample report includes a line by line description of the data items in the report mydd yy BESS EDI QIY bh m ss OOUMBIA S 29219 PROCESS DATE SUEMITIER ID GOP CONTROL NR BILLING PROVITER SERVICE TATE FR l mv d yy mvVdd yy EK Xxx MX XX mvdd yy mydd yy AX K HX EX mydd vy mVdd yy Sxxxk XXX XXX xX my dd yy mydh yy Sxxx Xxx XXX XX l mvy dd yy myc yy Sxxx Xxx XXX xX 4 11 1 Error Claim Summary Report The Error Claims Summary Report is generated if there are errors at the claim batch or file level of submitted electronic claims It provides the trading partner with specific reasons for front end edit errors The table following the sample report includes a line by line description of the data items in the report my dd ecyy BCESSC EDT G iney
104. mpanion Guide Here is an example of a real time response message using the HTTP MIME Multipart method HTTP 1 1 200 OK Content Length 2408 Content Type multipart form data boundary XbCY XbCY Content Disposition form data name PayloadT ype X12_271_Response_005010X279A1 XbCY Content Disposition form data name ProcessingMode RealTime XbCY Content Disposition form data name Payload D 81d4fae 7dec 11d0 a765 00a0c91e6da 6 XbCY Content Disposition form data name TimeStamp 2007 08 30T 10 20 34Z XbCY Content Disposition form data name Sender D PayerB XbCY Content Disposition form data name Receiver D HospitalA XbCY Content Disposition form data name CORERuleVersion 2 2 0 XbCY Content Disposition form data name ErrorCode Success XbCY Content Disposition form data name ErrorMessage None XbCY Content Disposition form data name Payload lt contents of file go here 1674 bytes long as specified above gt XbCY DECEMBER 2012 40 BlueCross BlueShield of South Carolina 276 277 Companion Guide Here is an example of a Batch Submission message using the HTTP MIME Multipart envelope method POST core eligibility HTTP 1 1 Host server_host server_port Content Length 244508 Content Type multipart form data boundary XbCY XbCY Content Disposition form data name PayloadT ype X12_270 Request_005010X
105. must report the NPI number in element NM109 using the qualifier XX in element NM108 If a provider is not eligible to receive an NPI either the Federal Taxpayer Identification Number FI or the provider s Service Provider Number SV may be used in element NM109 This can be the Billing or Rendering provider 51 2100C NM108 Identification Code Qualifier Fl SV XX Federal Taxpayer s Identification Number Service Provider Number Centers for Medicare amp Medicaid Services National Provider Identifier DECEMBER 2012 69 BlueCross BlueShield of South Carolina 276 277 Companion Guide Page Loop ID Reference Name Codes Notes Comments 54 2100D DMG Subscriber Demographic Required when the subscriber Information is the patient 55 2100D DMG02 Date Time Period If the subscriber is the patient this field must be populated with the subscriber s date of birth in CCYYMMDD format Otherwise do not submit this element as each request should only contain one DMG segment 56 2100D NM1 Subscriber Name 2100D NM108 Identification Code Qualifier This element is required whether the patient is the subscriber or a dependent and it must equal MI 57 2100D NM108 Identification Code Qualifier MI Member Identification Number 57 2100D NM109 Identification Code This element is required whether the patient is the subscriber or a dependent
106. n form data name CORERuleVersion 2 2 0 XbCY Content Disposition form data name ErrorCode Success XbCY Content Disposition form data name ErrorMessage None XbCY DECEMBER 2012 48 BlueCross BlueShield of South Carolina 276 277 Companion Guide Here is an example of an Envelope Processing Error message using the HTTP MIME Multipart envelope method HTTP 1 1 200 OK Content Length 2408 Content Type multipart form data boundary XbCY XbCY Content Disposition form data name PayloadT ype COREEnvelopeError XbCY Content Disposition form data name ProcessingMode RealTime XbCY Content Disposition form data name Payload D 81d4fae 7dec 1 1d0 a765 00a0a91 e6fa6 XbCY Content Disposition form data name TimeStamp 2007 08 30T10 20 34Z XbCY Content Disposition form data name Sender D PayerB XbCY Content Disposition form data name Receiver D HospitalA XbCY Content Disposition form data name CORERuleVersion 2 2 0 XbCY Content Disposition form data name ErrorCode VersionMismatch XbCY Content Disposition form data name ErrorMessage Expected Version X received version Y XbCY DECEMBER 2012 49 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 15 SOAP WSDL BlueCross BlueShield of South Carolina supports transactions formatted according to the Simple Object Access Protocol
107. na 276 277 Companion Guide A APPENDICES A1 Implementation Checklist BlueCross BlueShield of South Carolina suggests entities use this information as a checklist of steps to become a submitter Read and review this guide Contact BlueCross BlueShield of South Carolina Technology Support Center at 803 736 5980 or 800 868 2505 with questions if any Get user ID and password Send at least one test transaction These tests must be performed for each different transaction type that a trading partner is approved to submit to EDIG Begin submitting transactions B1 Business Scenarios These scenarios are intended to serve as examples of a typical relationship between entities and BlueCross BlueShield of South Carolina in regards to the Blue System Clearinghouse A submits transactions for Provider A Clearinghouse A wishes to provide real time services for Provider A so they register with their current payers to do real time transactions via their respective implementations In order to complete registration and successfully submit transactions on behalf of Provider A Clearinghouse A must get a copy of the shared secret 4 5 1 from Provider A to complete registration with BlueCross BlueShield of South Carolina Once this has occurred Clearinghouse A can send transactions for Provider A as well as any other clients it has a relationship with that are currently contracted with BlueCross BlueShield of South Carolina Software Vendor
108. ng Partner s representations and warranties in Article VII of this Agreement ii Trading Partner s failure to notify BlueCross BlueShield of South Carolina as required in Section 7 4 of this Agreement or iii actual exclusion during the term of this Agreement from any federal health care program as defined in the Social Security Act 1128B f Participation in Actions BlueCross BlueShield of South Carolina reserves the right at its option and expense to participate in the defense of any suit or action brought against Trading Partner or Business Associate arising out of any act or omission in connection with this Agreement Dispute Assistance Each Party will reasonably cooperate in providing necessary assistance to the other Party when the other Party is actively involved in a dispute with a third party concerning Data Transmissions that either are or reasonably could be the source of litigation with that third party Limitation of Liability Except claims or causes of action related to Trading Partner s actual or alleged breach of Article V of this Agreement or fraud by Trading Partner neither Party will be liable for any special incidental indirect exemplary or consequential damages resulting from any claim or cause of action arising out of any delay omission or error in any Data Transmission or the other Party s performance or failure to perform in accordance with the terms of this Agreement including without limitation loss
109. nical Report 3s also known as Implementation Guides are available that include format specifications for each transaction The ASC X12 TR3s that detail the full requirements for these transactions are available at http store x12 org store DECEMBER 2012 64 BlueCross BlueShield of South Carolina 276 277 Companion Guide 9 TRADING PARTNER AGREEMENTS 9 1 The Enrollment Process All clearinghouses and providers who submit claims directly to BlueCross BlueShield of South Carolina or BlueChoice HealthPlan must complete the appropriate Trading Partner Agreement and EDIG Enrollment form to receive a Trading Partner ID for claims submission and other transactions There is one Trading Partner Agreement for clearinghouses see below and another for hospitals and physicians see below who wish to transmit claims and other transactions directly with us 9 2 Clearinghouse Trading Partner Agreement The Clearinghouse Trading Partner Agreement must be completed by clearinghouses that transmit HIPAA compliant transactions directly to us on behalf of hospitals doctors and other health care professionals There is also an agreement for hospitals doctors and other health care professionals who wish to transmit HIPAA compliant transactions directly with us See Appendix D 9 3 Hospital and Physician Trading Partner Agreement The Hospital and Physician Trading Partner Agreement is for use by doctors and other health care professionals who intend on t
110. o purposes to identify the requesting partner for authorization and to track service usage for reporting This Consumer ID is tied internally to the public key you provide for authorization All BlueCross BlueShield of South Carolina Web services conform to the WS I Basic Profile v1 1 and implement security measures defined within the WS I Basic Security Profile v1 0 The minimum security measures required by BlueCross BlueShield of South Carolina are 1 All communication traversing public IP networks must be secured by transport layer encryption TLS v1 2 is preferred but TLS v1 0 or SSL v3 0 is acceptable if no alternatives exist BlueCross BlueShield of South Carolina can support I PSec based Virtual Private Networks and link layer encryption dedicated circuits on a case by case basis 2 All messages must contain a unique WS Security utility Timestamp within a WS Security header with the creation time and expiration time The period of validity for test environments is five minutes The period of validity for the production environment is one minute 3 Each web service request must contain a unique Message ID per WS Addressing standards 4 All web service requests must be digitally signed by the partner using a standard XML Digital Signature The signed elements must include a The SOAP body element b The WS Security timestamp element c The WS Addressing Message ID element The signature must employ XML Canonicalization v 1 0
111. of use revenues profits or savings even if a Party has been advised in advance of the possibility of such damages IX MISCELLANEOUS 9 1 Notices Any notice pertaining to this Agreement will be in writing Notice will be deemed given when personally delivered to the Party s authorized representative listed here or sent by means of a reputable overnight courier or by certified mail postage prepaid return receipt requested A notice sent by overnight courier or by certified mail will be deemed given on the date of receipt or refusal of receipt All notices will be addressed to the appropriate Party as follows DECEMBER 2012 100 BlueCross BlueShield of South Carolina 276 277 Companion Guide To BlueCross BlueShield of South Carolina I 20 Alpine Road AX 701 Columbia SC 29219 Attn Martha Owens Perry Title AVP Health Care Services To Trading Partner Address City State ZIP Code Attn Title 9 2 Amendments This Agreement may not be changed or modified except by an instrument in writing signed by each Party s authorized representative 9 3 Choice of Law This Agreement and the Parties rights and obligations hereunder are governed by and will be construed under the laws of the State of South Carolina 9 4 Jurisdiction Venue and WAIVER OF JURY TRIAL The Parties agree that any action or proceeding arising out of or related to this Agreement shall be instituted only in the federal district court in Columbia
112. ons that either are or reasonably could be the source of litigation with that third party 8 5 Limitation of Liability Except for the indemnification obligations in Article VII claims or causes of action related to Trading Partner s actual or alleged breach of Article V or fraud by Trading Partner neither Party will be liable for any special incidental indirect punitive exemplary or consequential damages resulting from any claim or cause of action arising out of any delay omission or error in any Data Transmission or the other Party s performance or failure to perform in accordance with the terms of this Agreement including without limitation loss of use revenues profits or savings even if a Party has been advised in advance of the possibility of such damages DECEMBER 2012 89 BlueCross BlueShield of South Carolina 276 277 Companion Guide IX MISCELLANEOUS 9 1 Notices Any notice pertaining to this Agreement will be in writing Notice will be deemed given when personally delivered to the Party s authorized representative listed here or sent by means of a reputable overnight courier or by certified mail postage prepaid return receipt requested A notice sent by overnight courier or by certified mail will be deemed given on the date of receipt or refusal of receipt All notices will be addressed to the appropriate Party as follows To BlueCross BlueShield of South Carolina I 20 Alpine Road AX 701 Columbia SC 29219 Attn
113. operates as a hospital or professional practitioner duly certified or licensed to provide health care services to Covered Individuals and includes without limitation extended care facilities skilled nursing facilities rehabilitation facilities home health agencies hospices physicians dentists clinical social workers ambulance services and hospitals or professional practitioners specifically certified or approved by HHS to provide reimbursable health care services to Medicare Eligible Individuals DECEMBER 2012 83 BlueCross BlueShield of South Carolina 276 277 Companion Guide 1 17 Security Access Codes mean alphanumeric codes that BlueCross BlueShield of South Carolina assigns to Trading Partner to allow Trading Partner access to BlueCross BlueShield of South Carolina s Operating System for the purpose of successfully executing Data Transmissions or otherwise carrying out this Agreement 1 18 Source Documents mean documents containing Data that are or may be required as part of a Data Transmission concerning a claim for payment of charges for medical services that a Provider furnishes or medical supplies that a Supplier sells to a Covered Individual Source Documents are subject to the security standards of Article V of this Agreement Examples of Data contained within a Source Document include without limitation Individual s name and identification number claim number diagnosis codes for the services rendered dates of service s
114. option EDI Gateway will request additional information from the trading partner such as source public IP address and public key We will complete all requests within seven to 14 business days Our SFTP server accepts SFTP client connections using the SSH2 secure protocol The client product our Network Operations department recommends using is SecureFX from VanDyke Software although any SFTP SSH2 client that supports public key authentication SSH2 public key DSA 1024 bit should work Files submitted through the SFTP VPN and NDM communication methods can either be segmented one segment per line with a valid non special character delimiter or a 1000 byte wrapped EDI format with each ISA starting in a new line 4 8 Connect Direct NDM Trading partners choosing this option will connect through AT amp T s AGNS network to BlueCross BlueShield of South Carolina s eServer using Sterling Commerce Connect Direct software The trading partner must acquire Connect Direct licensing directly from IBM Authentication is done with use of a unique login ID and password When this authentication is complete the trading partner s processes can copy files to a BlueCross BlueShield of South Carolina eServer dataset Acknowledgment and response files will be returned from BlueCross BlueShield of South Carolina s eServer to the trading partner Connect Direct is a product that moves all types of data It manages high performance transfers by providing
115. outh Carolina Obligations BlueCross BlueShield of South Carolina will a Make available to Trading Partner via electronic means data and Data Transmissions for which this Agreement grants Trading Partner access or authorization or as provided by law b Provide Trading Partner with at least sixty 60 days prior written notice of any change or addition to the BlueCross BlueShield of South Carolina Supplemental Implementation Guides code sets data elements or formats for Data Transmissions set forth in Section 3 1 a of this Agreement c Provide Trading Partner with Security Access Codes that will allow Trading Partner access to BlueCross BlueShield of South Carolina s Operating System BlueCross BlueShield of South Carolina reserves the right to change Security Access Codes at any time and in such manner as BlueCross BlueShield of South Carolina in its sole discretion deems necessary IV BUSINESS ASSOCIATES 4 1 4 2 4 3 Business Associate Obligations Trading Partner will ensure that Business Associate will be bound by the mutual obligations of the Parties set forth in Section 3 1 and Trading Partner s obligations set forth in Section 3 2 even though Business Associate is not a signatory to this Agreement Responsibility for Business Associates Trading Partner is liable to BlueCross BlueShield of South Carolina for any act failure or omission of any Business Associate with which Trading Partner contracts or that Trad
116. outh Carolina will have the unilateral right to terminate this Agreement immediately by providing Trading Partner with written notice of termination in the event of i a breach by Trading Partner of any section of Article V or of Article VII of this Agreement ii termination of any applicable business agreement between the Parties or iii Trading Partner any of its related business entities or any of its officers directors managing employees or Business Associates is charged with a criminal offense relating to one or more government contracts or government subcontracts or to federal health care programs as defined in Social Security Act 1128B f listed by a federal agency as debarred proposed for debarment or suspended or otherwise excluded from federal program participation including exclusion from participation in a federal health care program as defined in the Social Security Act 1128B f lil OBLIGATIONS OF THE PARTIES 3 1 Mutual Obligations The mutual obligations of BlueCross BlueShield of South Carolina and Trading Partner include the following a Transmission Format All standard transactions as defined by Social Security Act 1173 a and the Transaction Rules conducted between BlueCross BlueShield of South Carolina and Trading Partner or Business Associate will only use code sets data elements and formats specified by the Transaction Rules and the then current version of the BlueCross BlueShield of South Caro
117. period equal to the duration of such events Such automatic extension will have no effect on the exercise of either Party s right of voluntary termination of this Agreement under Section 2 2 of this Agreement No Waiver Failure or delay on the part of either Party to exercise any right power privilege or remedy in this Agreement will not constitute a waiver No provision of this Agreement may be waived by either Party except in a writing signed by an authorized representative of the Party making the waiver No Agency Nothing in this Agreement will place BlueCross BlueShield of South Carolina and Trading Partner in a relationship whereby either i is the principal or agent of the other for any purpose or ii has the authority to bind the other in any way Severability The provisions of this Agreement are severable If any provision of this Agreement is held or declared to be illegal invalid or unenforceable the remainder of the Agreement will continue in full force and effect as though the illegal invalid or unenforceable provision had not been contained in the Agreement Entire Agreement This Agreement together with its Exhibits and any applicable Riders and Amendments constitutes the entire understanding between the Parties with respect to the subject matter of this Agreement and supersedes and cancels all previous written or oral understandings agreements negotiations commitments and any other writing and communication by or between
118. r 2006 lt http www wpc edi com gt 65 71 2 The ASC X12 TR3s that detail the full requirements for these transactions are available at http store x12 org store DECEMBER 2012 103
119. r BlueCross BlueShield of South Carolina s Proprietary Information that comes to Trading Partner s attention and will cooperate with BlueCross BlueShield of South Carolina in the event that any litigation arises concerning the unlawful or unauthorized disclosure or use of Confidential Health Information or BlueCross BlueShield of South Carolina s Proprietary Information Operating Systems Security Each Party will develop implement and maintain measures necessary to ensure the security of each Party s own Operating System and each Party s records relating to its Operating System Each Party will document and keep current its security measures Each Party s security measures will include at a minimum the requirements and implementation features set forth in Social Security Act 1173 d and all applicable HHS implementing regulations VI RECORDS RETENTION AND AUDIT 6 1 6 2 Records Retention Trading Partner will maintain complete accurate and unaltered copies of all Source Documents from all Data Transmissions it receives from BlueCross BlueShield of South Carolina for not less than six 6 years from the date that Trading Partner receives them All retained records will be subject to the same security measures as data and Data Transmissions Trade Data Log BlueCross BlueShield of South Carolina and Trading Partner will each establish and maintain a Trade Data Log to record all Data Transmissions between the Parties during th
120. r circumstance that would warrant the institution of suspension or debarment proceedings or the finding of no responsibility or ineligibility on the part of Trading Partner or any director officer or employee of Trading Partner and f No payment has been made by Trading Partner or by any person on behalf of Trading Partner in connection with any government contract or government subcontract in violation of or requiring disclosure pursuant to the Foreign Corrupt Practices Act as amended 15 U S C 78dd 1 78dd 2 7 2 Legal Compliance Trading Partner will use reasonable efforts to comply and to cause Trading Partner s directors officers employees and Providers and Suppliers to comply in all material respects with all requirements of all laws pertaining to government contracts or government subcontracts the violation of which may result in Trading Partner or its directors officers or employees or other persons being charged with a criminal offense For purposes of this Section 7 2 laws mean all applicable statutes laws rules regulations permits decrees injunctions judgments orders rulings determinations writs and awards 7 3 Warranties Regarding Providers and Suppliers Trading Partner warrants that it will make no changes in the Data content of Data Transmissions or the contents of an Envelope received from Providers and or Suppliers Trading Partner further warrants that Trading Partner will advise Providers and Supp
121. r during service processing that the server is aware is temporary This error is typically returned when the service is too busy to service the request at the moment Clients SHOULD retry service calls that return this code without first modifying the request after some period of time The appcode is an application specific error code appended to the service fault code using another period For example a service wishing to return the application specific error code ORA 0435 would create a fault code of Server 500 ORA 0435 The application specific code is optional and not all will services return one The faultcode is prefixed with the namespace qualifier wrx which is mapped to the BlueCross BlueShield of South Carolina error namespace http services ocbssc com error 2 faultstring This element presents a short reasonably friendly explanation of the error This element is contained within the SOAP namespace http schemas xmlsoap org soap envelope DECEMBER 2012 51 BlueCross BlueShield of South Carolina 276 277 Companion Guide 3 detail This element contains details relating to the SOAP fault This element is contained within the SOAP namespace http schemas xmlsoap org soap envelope The child of the detail element is fault Detail in the BlueCross BlueShield of South Carolina namespace http services bcbssc com a Transaction UUID This element contains a 36 character Universally Unique Identifier that i
122. r with timely notice of the existence of such action Trading Partner will provide information documents and other cooperation as reasonably necessary to assist BlueCross BlueShield of South Carolina in establishing its defenses to such action 8 2 Breach of Warranties Trading Partner will indemnify and hold BlueCross BlueShield of South Carolina harmless from and against any and all liability resulting from i any misrepresentation in Trading Partner s representations and warranties in Article VII of this Agreement ii disputes between BlueCross BlueShield of South Carolina and Providers and or Suppliers regarding Data Transmissions that are the subject of this Agreement iii Trading Partner s failure to notify BlueCross BlueShield of South Carolina as required in Section 7 4 of this Agreement or iv actual exclusion during the term of this Agreement from any federal health care program as defined in the Social Security Act 1128B f 8 3 Participation in Actions BlueCross BlueShield of South Carolina reserves the right at its option and expense to participate in the defense of any suit or action brought against Trading Partner Providers or Suppliers arising out of any act or omission in connection with this Agreement 8 4 Dispute Assistance Each Party will reasonably cooperate in providing necessary assistance to the other Party when the other Party is actively involved in a dispute with a third party concerning Data Transmissi
123. r you have completed the form The Trading Partner Agreement is a legal document All trading partners are required to print complete and return the originally signed hard copy via mail prior to being moved to production status The BlueCross BlueShield of South Carolina Trading Partner Agreements can be found at the HIPAA Critical Center The PGBA Trading Partner Agreement can be found on MyTRICARE com in the Electronic Claims Filing section If you are a prospective BlueCross BlueShield of South Carolina commercial or BlueChoice HealthPlan trading partner print and mail a hard copy of the completed Trading Partner Agreement to BlueCross BlueShield of South Carolina Technology Support Center EDI Enrollment l 20 at Alpine Road AA E05 Columbia SC 29219 If you are a prospective PGBA LLC trading partner print and mail a hard copy of the completed Trading Partner Agreement to Palmetto GBA Attention EDIG Operations AG 280 2300 Springdale Drive Building One Camden SC 29020 1728 DECEMBER 2012 76 BlueCross BlueShield of South Carolina 276 277 Companion Guide This table will help trading partners complete the enrollment form Form Field Name Instructions for Field Completion Date Enter today s date Action Requested New Trading Partner ID Change Cancel Indicate the action to be taken on the enrollment form Note Depending on the requested action different fields of this form are required Thes
124. rading Partner s directors officers employees vendors agents or Business Associate DECEMBER 2012 99 BlueCross BlueShield of South Carolina 276 277 Companion Guide Vill INDEMNIFICATION 8 1 8 2 8 3 8 4 8 5 Indemnification of BlueCross BlueShield of South Carolina Trading Partner will indemnify defend and hold BlueCross BlueShield of South Carolina harmless from any and all claims actions damages liabilities costs or expenses including without limitation reasonable attorneys fees arising out of any act or omission of Trading Partner Business Associate or their respective employees subcontractors or other persons in the performance of this Agreement BlueCross BlueShield of South Carolina will have the option at its sole discretion to employ attorneys to defend any such claim action or proceeding arising out of these acts or omissions the costs and expenses of which will be Trading Partner s responsibility BlueCross BlueShield of South Carolina will provide Trading Partner with timely notice of the existence of such action Trading Partner will provide information documents and other cooperation as reasonably necessary to assist BlueCross BlueShield of South Carolina in establishing its defenses to such action Breach of Warranties Trading Partner will indemnify and hold BlueCross BlueShield of South Carolina harmless from and against any and all liability resulting from i any misrepresentation in Tradi
125. ransmitting HIPAA compliant transactions directly to us Completing this form will allow you to send and receive HIPAA compliant transactions when you will not be using a clearinghouse to process transactions Please be sure to complete the entire agreement and Exhibit A the EDIG Enrollment form which follows the agreement Important Information If you plan to use a vendor or clearinghouse to conduct your HIPAA transactions please have them contact us as soon as possible if they have not already done so See Appendix D Appendix E and Appendix F 9 4 Enrollment Process for Direct Transactions 1 The clearinghouse or provider completes the appropriate Trading Partner Agreement and mails it to the address on the bottom of the form 2 Once the Technology Support Center receives the completed agreement an authorized representative will review and sign the Trading Partner Agreement file the original and return a copy of the agreement to the Trading Partner 3 The EDIG Trading Partner enrollment form is sent to the operations department for assignment of the Trading Partner ID number Please allow three to four days for processing 4 After assignment of the Trading Partner ID number the contact person identified on the EDIG Enrollment form will be notified by email or phone with production and test Trading Partner ID numbers 5 Call BlueCross EDIG Operations at 800 868 2505 to request the passwords and all other information required to begin
126. rding the structure or data included within the body of the MIME multipart message will be reported at this level in a response of type multipart form data o Success processed successfully Payload ID Required missing Payload ID or did not conform to format User Name Required missing User Name or did not conform to format Password Required missing Password or did not conform to format Payload Required missing Payload or did not conform to format Sender ID Required missing Sender ID or did not conform to format Receiver ID Required missing Receiver ID or did not conform to format CORE Rule Version Required missing CORE Rule Version or did not conform to expected format e Transaction X12 Errors concerning ANSI transaction compliancy will be returned as a MIME multipart form data message containing the associated ANSI response data i e TA1 or 999 000000 0 4 14 3 Submission Retrieval 4 14 3 1 Real time Real time requests sent to the BlueCross BlueShield of South Carolina submitted to this type of URL https services bcbssc com ENV REG Where ENV Environment UNIT SYST QUAL PROD REG Region Specific host region if needed or default value if not SVCNAME Name of the Web service to be called 1 for MIME and SOAP em must be 4 14 3 2 Batch Batch requests sent to the BlueCross BlueShield of South Carolina system must be submitted to this type of URL https services bcbssc
127. ross BlueShield of South Carolina and Trading Partner agree otherwise the recipient of data or Data Transmission will use at least the same level of protection for any subsequent transmission as was used for the original transmission Security Access Codes The Security Access Codes that BlueCross BlueShield of South Carolina issues to Trading Partner will when affixed to Data Transmissions be legally sufficient to verify the identity of the transmitter and to authenticate the Data Transmission thereby establishing the Data Transmission s validity Data Transmissions having a Security Access Code affixed to them will be deemed to have been written or signed by the sender Computer printouts of the information contained in such correspondence and documents that have been electronically or magnetically recorded and kept in the normal course of the sender s or receiver s business will be considered original business records admissible in any judicial arbitration mediation or administrative proceeding to the same extent and under the same conditions as other business records originated and maintained in documentary form 3 2 Trading Partner Obligations Trading Partner will a Not copy reverse engineer disclose publish distribute alter or use Data Data Transmission or Envelope for any purpose other than for which BlueCross BlueShield DECEMBER 2012 96 BlueCross BlueShield of South Carolina 276 277 Companion Guide 3 3
128. s 1 faultcode This element indicates what kind of error occurred and with whom the fault lies The format of the faultcode is lt class gt lt code gt lt appcode gt omitting the namespace prefix This element is contained within the SOAP namespace http schemas xmlsoap org soap envelope The class indicates on which side of the service transaction the source of the error lies If the error is caused by missing or incorrect data from the caller the class shall be the string Client If the error is caused for any reason unrelated to the message s contents the class shall be the string Server The separator between class and code is a period ASCII 46 UTF 8 0x2E The code is a three digit code corresponding to the HTTP status code most closely associated with the condition For example passing invalid credentials should result in a faultcode of Client 401 as the message s contents were the cause of the error and 401 is the HTTP status code for Unauthorized DECEMBER 2012 50 BlueCross BlueShield of South Carolina 276 277 Companion Guide HTTP status codes are used as they are familiar to most web service developers the vast majority of client libraries have constants defined for these status codes and they allow the aggregation of large numbers of errors into a small number of codes While not a comprehensive list some commonly used error codes are Client 400 Bad Request The data provided by
129. s used by BlueCross BlueShield of South Carolina support personnel to retrieve information about a web service transaction from our tracking databases The UUID should always be supplied when requesting troubleshooting assistance from BlueCross BlueShield of South Carolina support This element is contained within the BlueCross BlueShield of South Carolina namespace http services bcbssc com b Error Date This element contains the date that the fault occurred in the format YYYY MM DD e g 2010 08 19 The error Date should always be supplied when requesting troubleshooting assistance from BlueCross BlueShield of South Carolina support This element is contained within the BlueCross BlueShield of South Carolina namespace http services bcbssc com c Error Time This element contains the time that the fault occurred in the format HH MM SS TMZ e g 00 21 38 EDT The error Time should always be supplied when requesting troubleshooting assistance from BlueCross BlueShield of South Carolina support This element is contained within the BlueCross BlueShield of South Carolina namespace http services bcbssc com 4 15 4 Error Reporting There are three levels of error validation involved in a BlueCross BlueShield of South Carolina SOAP transaction e HTTP Errors with connectivity authorization etc will be reported at this level O O O O HTTP 200 OK success HTTP 202 Accepted batch submission accepted not necessarily pro
130. sccestivedeesetessceeesseeesereestevcuvedeeseteaveddesetveavedeesciseacaee 59 8 ACKNOWLEDGMENTS a aia aaa a meee aa Move adisi tees bonne reas Aaa Maviedear sates 64 8 1 EDIG Acknowledgment and Response Transactions Matrix ccceeeeeeeeeeeeeeeeeeeeeeaeees 64 9 TRADING PARTNER AGREEMENTS ccececeeeeeecececesecececacacecaeaeeeseeeeeseeeseeeeeesesesesenenens 65 9 1 The Enrollment Process ssas rice ceeceeew checeevecvec weed oneegivecVerecdavecevecvecsevedsuretuseskveeveeeer s 65 9 2 Clearinghouse Trading Partner Agreement ceceeeeeeee cece cnet cesses ee ease eeeeaeaeaeeeneeeeaeaes 65 9 3 Hospital and Physician Trading Partner Agreement ceeeee cece ee ee ee eeeeeeeeaeeeeeeeeeeaeaes 65 9 4 Enrollment Process for Direct Transactions cc cccece cece eee e cece teen eee ta sean ee eaenaeeenaeeas 65 9 5 Enrollment for Providers Using a Clearinghouse cccceeeeeceeeeeeeeeeeeeeeeeeeaeeeeeeeeeeeas 66 10 Transaction Specific INFOrMAtION cc cece cece eee eee eee ene enn ene AENEA senses EEVUE ean SAKUR AE 67 As APPENDICES amp a aa aa aa aaan a EEA vent sca E tiesto EA EEA TA a AANA ANEN 74 AL lmplementation Checklist xc cveesscseserweceswsess coaseeaecuevew sa cpusceresgisendeeie de enebe det aivan iasi 74 B1 BUSINESS SGENANIOS 2 te cacwed ceeded cbosawcoaeea Sheds hicndan eta cnetavecs e e e a a aeaa N a e Aaen 74 C1 Frequently Asked Questions cccccceeescnseceaeeeeeneeeeaenseseenaeseaeneesn
131. services bcbssc com xmins rsp http services bcbssc com response xmins wrx http services bcbssc com error gt lt soap Body gt lt soap Fault gt lt faultcode gt wrx Client 401 lt faultcode gt lt faultstring gt Unauthorized lt faultstring gt lt detail gt lt bcbs faultDetail gt lt bcbs transactionUUID gt a58de2da 167c 4779 8edf d5b758c62b0e lt bcbs transactionUUID gt lt bcbs errorDate gt 2010 08 19 lt bcbs errorDate gt lt bcbs errorTime gt 00 21 38 EDT lt bcbs errorTime gt lt ocbs faultDetail gt lt detail gt lt soap Fault gt lt soap Body gt lt soap Envelope gt DECEMBER 2012 54 BlueCross BlueShield of South Carolina 276 277 Companion Guide 4 16 General Specifications Applicable to Both Envelope Methods The following sections specify requirements of the CORE Phase II Connectivity Rule that are applicable to both envelope methods HTTP MIME Multipart and SOAP WSDL 4 16 1 Request and Response Handling HTTP S supports a request response message pattern meaning that the sender submits a message and then waits for a response from the message receiver This works well for the submission of both batch and real time ASC X12 messages but the response message from the receiver is different depending on whether the sender s message is a real time request batch submission or batch request pickup 4 16 2 Submitter Authentication and Authorization Handling X 509 Certificate based authentication o
132. services that a Provider furnishes or medical supplies that a Supplier sells to a Covered Individual Source Documents are subject to the security standards of Article V of this Agreement Examples of Data contained within a Source Document include without limitation Individual s name and identification number claim number diagnosis codes for the services rendered dates of service service procedure descriptions applicable charges for the services rendered the Provider s or Supplier s name and or National Standard Identifier and signature Supplier means a person or organization engaged in the business of selling or leasing durable medical equipment or supplies to Covered Individuals Trade Data Log means the complete written summary of Data and Data Transmissions exchanged between the Parties over the period of time this Agreement is in effect and includes without limitation sender and receiver information and transmission date time and general nature ll TERM AND TERMINATION 2 1 2 2 2 3 Term of Agreement This Agreement will remain in effect for an initial period of three 3 year s from the Effective Date and will automatically renew for successive periods of three 3 year s unless terminated pursuant to Section 2 2 or Section 2 3 Voluntary Termination Either Party may terminate this Agreement on one hundred twenty 120 day s prior written notice to the other Party Termination for Cause BlueCross BlueShield of S
133. t will be made directly either to Providers on behalf of the Individual or directly to the Individual at BlueCross BlueShield of South Carolina s discretion 1 12 Individually Identifiable Health Information means any Health Information including demographic information collected from an Individual that is created or received by a Provider health plan employer or health care clearinghouse and either i identifies an Individual or ii creates a reasonable basis to believe the information can be used to identify the Individual 1 13 Operating System means the equipment software and trained personnel necessary for a successful Data Transmission 1 14 Payor means a business organization that provides benefit payments for certain services or supplies rendered or sold to Covered Individuals or their eligible dependents under the terms conditions limitations and exclusions of a health benefit program issued or administered by the Payor 1 15 Proprietary Information means information used or created by BlueCross BlueShield of South Carolina in the conduct of its business activities that is not normally made available to BlueCross BlueShield of South Carolina s customers competitors or third parties the disclosure of which will or may impair BlueCross BlueShield of South Carolina s competitive position or otherwise prejudice BlueCross BlueShield of South Carolina s ongoing business 1 16 Provider means a customer of Trading Partner that
134. the account Technical Contact s Information The name email address telephone number and fax number of the trading partner s technical contact This is the person BlueCross BlueShield of South Carolina EDIG will contact if there are technical questions or problems After Hours Technical Contact s Information The name email address telephone number and fax number of the trading partner s after hours technical contact This is the person BlueCross BlueShield of South Carolina EDIG will contact if there are technical questions or problems after normal business hours On Call Technical Contact s Information The name email address telephone number and fax number of the trading partner s on call technical contact This is the person BlueCross BlueShield of South Carolina EDIG will contact if there are technical questions or problems after normal business hours when it is unable to contact the after hours technical contact Transaction Volume Estimates DECEMBER 2012 Mark yes Y or no N for each mode If you mark yes indicate the average number of transactions you anticipate submitting each week 78 BlueCross BlueShield of South Carolina 276 277 Companion Guide a South Carolina BlueCross BlueShield of South Carolina EDIG Trading Partner an independem e am i Enrollment Form ASC X12N Transactions ami Aha Veield amp ninisi Date Action Requested a
135. the client is badly formed or not sufficient for the service to process successfully Clients SHOULD NOT retry service calls that return this code without first modifying the request 401 Unauthorized The client did not provide valid credentials or is not permitted to consume this service Clients SHOULD NOT retry service calls that return this code without first modifying the request 403 Forbidden The service refuses to perform the requested function for some reason usually because the consumer is not permitted to consume the service The service middleware returns this error code when consumers are not authorized to consume the service they are requesting Clients SHOULD NOT retry service calls that return this code without first modifying the request 404 Not Found The service could not locate an appropriate resource to return for the request This might be returned when a document is requested that the service cannot find Clients MAY retry service calls that return this code without first modifying the request Server 500 Internal Server Error Indicates a malfunction or technical error during service processing Examples of 500 errors include an unavailable database MQ channel or a generic error thrown by the service itself unrelated to client input Clients MAY retry service calls that return this code without first modifying the request 503 Service Unavailable Indicates a malfunction or technical erro
136. try again or Q to quit Q will take you back to the Main Menu and ENTER will prompt you for the user ID or password depending on where you are at 4 The system will prompt you with this screen DECEMBER 2012 21 BlueCross BlueShield of South Carolina 276 277 Companion Guide REDI EDIGATEWAY TEST HyperTerminal Fie Edt View Cal Transfer Help Dis sis cls Welcome to the password change facility Do you want to change your password Y N pected 0 01 57 rico s208 FOL gas UM pue eeso p 5 Enter N and you will return to the Main Menu Or enter Y and follow the instructions on the screens You will be asked for your User ID and Current Password REDI EDIGATEWAY TEST HyperTerminal fie Edt View Call Transfer Help Dies 213 ala a Welcome to the password change facility Please enter your log in user id Connected 0 02 27 Krio Mis200ew1 Ro CAPS MM o ieeie DECEMBER 2012 22 BlueCross BlueShield of South Carolina 276 277 Companion Guide REDIL EDIGATEWAY TEST HyperTerminal Fle Edt View Col Transfer Help Os 213 Cl l Welcome to the password change facility Please enter your log in user id 1GWO881SCQ Please enter your current password KConmected 0 03 02 yri00 fiszooee1 Scho caps faim pue Preeto 6 The system will prompt you to enter the new password twice REDI EDIGATEWAY TEST HyperTerminal Fle Edt View Cal Trasfer Help Dis 213
137. ual who is eligible for payment of certain services or supplies rendered or sold to the Individual or to the Individual s eligible dependents under the terms conditions limitations and exclusions of a health benefit program issued or administered by BlueCross BlueShield of South Carolina or a health benefit program issued or administered by another Payor 1 5 Data Transmission means automated transfer or exchange of data pursuant to the terms and conditions of this Agreement between BlueCross BlueShield of South Carolina and Trading Partner by means of their respective Operating Systems which are compatible for that purpose and includes without limitation Electronic Data Interchange EDI Electronic Remittance Advice ERA and Electronic Media Claims EMC transmissions 1 6 Electronic Data Interchange EDI means the automated exchange of business documents from application to application DECEMBER 2012 82 BlueCross BlueShield of South Carolina 276 277 Companion Guide 1 7 Electronic Media Claims EMC means automated methods of submitting claims for payment of medical services or supplies rendered or sold by a Provider or Supplier to an Individual 1 8 Electronic Remittance Advice ERA means a document containing information pertaining to the disposition of a specific claim for payment of services or supplies rendered to an Individual that a Provider or Supplier files with BlueCross BlueShield of So
138. uth Carolina on the Individual s behalf The documents include without limitation information such as the Provider or Supplier name and address Individual s name date of service amount billed amount paid whether the claim is approved or denied and if denied the reason for the denial 1 9 Envelope means a control structure in a format required by this Agreement for the electronic interchange of one or more encoded Data Transmissions between BlueCross BlueShield of South Carolina and Trading Partner 1 10 Health Information means any information whether oral or recorded in any form or medium that i is created or received by a Provider health plan public health authority employer life insurer school university or health care clearinghouse and ii relates to the past present or future physical or mental health or condition of an Individual the provision of health care to an Individual or the past present or future payment for the provision of health care to an Individual 1 11 Individual means a person whose claims for services or supplies may be eligible to be paid under the terms of an applicable governmental or private program for which BlueCross BlueShield of South Carolina processes or administers claims and specifically includes without limitation Medicare Eligible Individuals Medicaid Eligible Individuals and Covered Individuals Trading Partner acknowledges and agrees that claim payments made according to this Agreemen
139. veloping X12 Transactions X12 Inbound Transactions This table lists envelope instructions for inbound to EDI Gateway HIPAA X12 transactions Segmentld Data Element Description ISA01 Authorization Info Qualifier 03 ISA02 Authorization Information EDIG assigned Trading Partner ID ISA03 Security Information Qualifier 00 ISA04 Security Information None ISA05 Interchange ID Qualifier 01 14 20 22 27 28 29 30 33 ZZ selected by trading partner ISA06 Interchange Sender ID Assigned by trading partner ISA07 Interchange ID Qualifier 30 qualifier indicating U S Federal Tax Identification Number ISA08 Interchange Receiver ID Destination Entity U S Federal Tax Identification Number ISA09 Interchange Date Populated by trading partner ISA10 Interchange Time Populated by trading partner ISA11 Repetition Separator Assigned by trading partner ISA12 Interchange Control Version 00501 Number ISA13 Interchange Control Number Assigned by the trading partner must be unique for 12 months ISA14 Acknowledgment Requested Assigned by the trading partner ISA15 Usage Indicator P T production or test indicator ISA16 Component Element Separator Assigned by the trading partner GS01 Functional Identifier Code Populated by trading partner GS02 Application Sender s Code EDIG assigned trading partner ID GS03 Application Receivers Code Destination Entity U S Federal
140. ver SSL24 Submitter Authentication Standard D in the Conformance Requirements 4 1 using the Secure Sockets Layer SSLv3 0 open standard for client certificate based authentication DECEMBER 2012 55 BlueCross BlueShield of South Carolina 276 277 Companion Guide 5 CONTACT INFORMATION 5 1 EDI Customer Service and Technical Assistance EDI Gateway s production environment is accessible 24 hours a day seven days a week with the exception of weekly maintenance performed Sundays between 3 p m and 10 p m EDI Gateway s test environment is accessible Monday through Saturday from 5 a m to 10 p m We send notifications of EDI Gateway outages to trading partners via email We generally send notifications of scheduled outages with two days prior notice We send notifications of unscheduled outages as quickly as the outage is reported Please call the BlueCross BlueShield of South Carolina Technology Support Center at 803 736 5980 or 800 868 2505 with questions or to report problems 5 2 Provider Service Number If you have questions regarding information related to subscribers that are non technical please contact BlueCross BlueShield of South Carolina at 800 334 2583 5 3 Applicable Web Email Contact Information Additional information is available online at www SouthCarolinaBlues com DECEMBER 2012 56 BlueCross BlueShield of South Carolina 276 277 Companion Guide 6 CONTROL SEGMENTS ENVELOPES 6 1 EDIG Specifications for En
141. vider DO Dependent Name DQ Supervising Physician E1 Person or Other Entity Legally Responsible for a Child E2 Person or Other Entity With Whom a Child Resides E7 Previous Employer E9 Participating Laboratory DECEMBER 2012 61 BlueCross BlueShield of South Carolina 276 277 Companion Guide FA Facility FD Physical Address FE Mail Address GO Dependent Insured G3 Clinic GB Other Insured GD Guardian Gl Paramedic GJ Paramedical Company GK Previous Insured GM Spouse Insured GY Treatment Facility HF Healthcare Professional Shortage Area HPSA Facility HH Home Health Agency 13 Independent Physicians Association IPA IJ Injection Point IL Insured or Subscriber IN Insurer LI Independent Lab LR Legal Representative MR Medical Insurance Carrier MSC Mammography Screening Center OB Ordered By OD Doctor of Optometry OX Oxygen Therapy Facility PO Patient Facility P2 Primary Insured or Subscriber P3 Primary Care Provider P4 Prior Insurance Carrier P6 Third Party Reviewing Preferred Provider Organization PPO P7 Third Party Repricing Preferred Provider Organization PPO PRP Primary Payer PT Party to Receive Test Report PV Party performing certification PW Pickup Address QA Pharmacy QB Purchase Service Provider QC Patient QD Responsible Party QE Policyholder QH Physic
142. ypes and will respond on the 277 with the noted service types Requested service types other than the ones listed here will result in a default list of responses in the 277 276 REQUEST EQ 277 RESPONSE DESCRIPTION 03 Dependent 13 Contracted Service Provider 17 Consultant s Office 1E Health Maintenance Organization HMO 1G Oncology Center 1H Kidney Dialysis Unit 11 Preferred Provider Organization PPO 10 Acute Care Hospital 1P Provider 1Q Military Facility 1R University College or School 1S Outpatient Surgicenter 1T Physician Clinic or Group Practice 1U Long Term Care Facility 1V Extended Care Facility 1W Psychiatric Health Facility 1X Laboratory 1Y Retail Pharmacy 1Z Home Health Care 28 Subcontractor 2A Federal State County or City Facility 2B Third Party Administrator 2D Miscellaneous Health Care Facility 2E Non Health Care Miscellaneous Facility 2l Church Operated Facility 2K Partnership 2P Public Health Service Facility 2Q Veterans Administration Facility 2S Public Health Service Indian Service Facility 2Z Hospital Unit of an Institution prison hospital college infirmary etc 30 Service Supplier 36 Employer 3A Hospital Unit Within an Institution for the Mentally Retarded 3C Tuberculosis and Other Respiratory Diseases Facility 3D Obstetrics and Gynecology Facility 3E Eye E

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