No. Regardless of practice size, all providers transmitting designated transactions electronically are subject to the HIPAA Administrative Simplification requirements. Small practices are exempt from the Administrative Simplification Certificate Act (ASCA) provision that excludes paper claims from Medicare coverage. Small practices will be able to continue to submit paper claims. ASCA defines a small practice or supplier as:

• A provider of services with fewer than 25 full-time equivalent employees or
• A physician, practitioner, facility, or supplier (other than provider of services) with fewer than 10 full-time equivalent employees.

BCBSRI has developed a partner testing approach to ensure trading partner transactions are HIPAA compliant and meet BCBSRI business rules. The extensive testing required during the partner testing phase should result in a smooth transition to production. In general, the major components are:

• Complete the Trading Partner Agreement and Trading Partner Registration form.
• Successfully test files using the Foresight Online Validator tool.
• Successfully test files through the Blue Cross end-to-end test environment (Phase 2).

For additional information on HIPAA Partner Testing contact the BCBSRI Service Desk at 1-855-721-4211 or hipaa.edi.support@bcbsri.org. An EDI analyst will work with you during each phase of partner testing.

You can obtain copies of our Companion Guides in the HIPAA Transactions Documents above.

BCBSRI EDI Gateway must accept any ANSI-compliant home infusion claim submitted on either 837I or 837P. However, BCBSRI will reject any 837P home infusion claim during the internal business editing process as “not a contracted service for this form type.” A home infusion provider would have to use the 837I format in order to receive payment under the terms of their contract.

In situations where there is no clear national code set equivalent, the closest valid national code set will be selected and used to process applicable claims.

We accept the HIPAA limits—50 lines for Professional claims and 98 lines for Institutional claims. If a professional claim has more than 50 lines, it is rejected up front and will appear on your Provider Control Report. If we receive an institutional claim with more than 98 lines, the claim is split manually.

You should always expect a 999 Acknowledgement and Plain Language 999 for each 837 file you submit. If a reasonable time has elapsed since file submission and you have yet to receive the appropriate 999, please contact BCBSRI Service Desk at (401) 751-1673 or 1-855-721-4211 for assistance.

Yes, for those providers who are not enrolled in direct deposit, the current paper remittance advice will be produced.

Yes. You will need to change the first position of the Submitter ID from "T" (test) to "P" (production). You will also need to change the ISA15 from "T" (test) to "P" (production).

The Provider Control Reports identify claims that were not accepted for claims adjudication. This reject report will list any claim that is rejected from our front-end edit process and the reason the claim rejected. These claims must be corrected by you and resubmitted for processing.

Type 1 NPIs are healthcare providers, such as physicians and dentists. Type 2 NPIs are organizations such as facilities, hospitals, home health agencies, labs, and DME suppliers.