Riverbend

Electronic Billing (EDI) FAQ

What software do you offer for electronic billing?

When transmitting per the ANSI format guidelines, you can choose one of three ways to assure your files will be sent successfully.

-Download and utilize the PCACE Pro32 software we offer for no charge.

-Purchase software from our list of Approved Vendors that have already tested with us and are currently sending electronic files.

-Use your current software and import your claims into PCACE Pro32 using our Printlink option prior to transmitting.

For Technical Support please call the eBusiness Service Center at 423-535-5717 (7/11/2007)

What is PC-ACE?

The software product, PC-ACE Pro32, is a comprehensive claims management system that includes: electronic claim submission, claim import from existing office management system, remittance advice translation, field-level edit validation, code validation, claim payment history, backup and restore functions, on-line help, and many other features.
For additional information regarding PC-ACE Pro32, contact our Marketing staff at (423) 535-3057 or email ecomm_marketing@bcbst.com.
To obtain PC-ACE Pro32 software, contact our System Configuration Staff at (800) 924-7141 speak 'CONTRACT' then speak 'ENROLLMENT' or email ecomm_sysconfig@bcbst.com. (7/11/2007)

How often is PC-ACE updated?

PCACE PRO32 is a free billing software that is available on our website.
Once the Full Installation version is installed on your system, you will need to download a quarterly update to stay current with time sensitive edits required by the Centers for Medicare and Medicaid Services. (7/11/2007)

Will a provider be set up to send claim electronically at the same time they are set up to be a Riverbend Medicare provider?

No. Riverbend's Enrollment area sets the provider up with a Legacy/Provider ID. Once you have the Legacy/Provider ID you can then be set up as an electronic submitter by the BlueCross and BlueShield of Tennessee E-Commerce Department. You will need to fill out the Electronic Provider Profile (7/11/2007)

Who can answer my questions regarding filling out the Electronic Provider Profile?

You may contact the Enrollment Staff at 800-924-7141 or you may email your questions to ecomm_sysconfig@bcbst.com. For Technical Support assistance please call the eBusiness Service Center at 423-535-5717. (7/11/2007)

How do I access DDE (Direct Data Entry) or FSS (Florida Shared System)?

If you do not have access to the system, you may purchase a copy of the 3270 Emulation Software. For more information on this software please review the following Product Summary. To request a copy of the software, please submit an Electronic Provider Profile.

(8/29/2007)

What electronic reports are available for review of the claims submitted? How do I obtain the reports?

Once there is an electronic file submission, the following reports will generate.

-Functional Acknowledgment / 997
-Receipts Confirmation Report / EM735R01 and EM745R01
-Medicare Part A Inbound Reject Report
-Summary of Process, Pended or Returned Claims Report / 201
-Electronic Remittance Advice (ERA) / ANSI 835


These are all electronic reports and may be downloaded from your electronic mailbox. (7/11/2007)

Are the electronic filing guidelines the same as the hard copy claim guidelines?

The requirements for an ANSI 837 Electronic file and the UB-04 Institutional claim form are not the same.

Specifications for the ANSI 837 can be found on www.wpc-edi.

UB-04 claim requirements can be found on the website for the Centers for Medicare and Medicaid Services at www.cms.hhs.gov. (7/11/2007)

What additional specification information do I need to create an electronic file?

In addition to the ANSI specifications listed on www.wpc-edi.com we offer additional Support Guides such as:

-837I Companion Implementation Guide
-ANSI Level 1 and Level 2 Self-Testing Procedures
-ANSI Receipts Confirmation Reports
-EC Gateway BBS User Guide (7/11/2007)

How do I interpret the edits listed on the confirmation report?

The Institutional Edits listed are on the Confirmation Report (EM735R01) for rejected claims and come with a more detailed description of the problem. (7/11/2007)

How do I know if my vendor can submit to you?

Check the approved vendor list.  (7/11/2007)