Vendor Testing

If you will be sending claims directly to Health Advantage and are using a software vendor, you should contact that vendor and ask if the vendor has tested its software with us. Please review our HIPAA Compliant Vendors List (28 KB PDF) for a list of all of the vendors and clearinghouses that have successfully tested with Health Advantage. If your vendor has no plans to test with Health Advantage, you must follow the directions in the Individual Testing section. We will allow vendors to receive "blanket approval" for their software products. This means the vendor can test on behalf of their customers. Once testing is successfully concluded, the vendor can complete a vendor Blanket Approval form, letting Health Advantage know which clients the testing covered. In addition, the following steps must be completed:

• You must complete a Trading Partner Agreement (TPA) (151 KB PDF). The completed document must be returned to EDI Services via the U.S. Postal Service to the address noted below or via fax to (501) 378-2265.
  
  
• Once EDI Services has processed your TPA (151 KB PDF) and testing is successfully concluded, you will be contacted to establish a date for beginning your claims submissions to the Gateway.

Individual Testing

If your vendor will not be testing the new format for you, it will be necessary for you to submit test transactions for yourself. Several documents, including the X12N Transaction User Guide (622 KB PDF) and the Companion Documents ( HA Professional (222 KB PDF) and Institutional (202 KB PDF) ) and Health Advantage Billing Requirements will be helpful during this process.

Once your TPA (151 KB PDF) is processed and your submitter ID has been added to Gateway security, you may log on and submit a test file. Gateway Instructions (58 KB PDF) will tell you how to access our electronic gateway and upload a file. You may also find the general testing guidelines contained in the X12N Transaction User Guide (622 KB PDF) and Health Advantage Billing Requirements helpful. 

• You must transmit a 4010A1 test file containing all the specialties for which you routinely bill.
  
  
• Reports (ANSI 997, Batch Processing Report and/or ANSI TA1) will normally be returned to your Gateway electronic mailbox within 30 minutes. The EDI Report User Guide (100 KB PDF) will be helpful in understanding these reports. EDI Services will contact you via telephone a few days after transmission to discuss your test file.
  
  
• You must complete a Trading Partner Agreement (TPA) (151 KB PDF) This document contains important information about submitting claims in the ANSI format. This document must be received and processed by EDI Services before a submitter ID will be issued. The completed document must be returned to EDI Services via the U.S. Postal Service to the address noted below or via fax to (501) 378-2265. A submitter number will not be issued until the TPA (151 KB PDF) is processed by EDI Services.
  
  
• Once testing has successfully concluded, EDI Services will contact you to establish a date for beginning your claims submissions to the Gateway.
  
  
• Test data is not processed and must be transmitted again after you have successfully completed testing and are placed in production mode.
  

Clearinghouse Testing

If you submit claims through a third party, your clearinghouse or billing agent should test the new formats on your behalf. Please review our HIPAA Compliant Vendors List (28 KB PDF) for a list of all of the vendors and clearinghouses that have successfully tested with Health Advantage and have blanket approval. If you do not find your clearinghouse's name on this list, we suggest you contact your clearinghouse and inquire about its testing status with Health Advantage. All organizations that have successfully tested with Health Advantage have been issued a certification letter, which you may want to request if the clearinghouse's name is not included in the list. Remember, your clearinghouse or billing agent will always be your first point-of-contact for enrollment and/or claims questions.

• If you have been submitting to EDI Services directly and will begin submitting through a clearinghouse, or if you are changing from one clearinghouse to another, you must submit a Letter of Authorization (LOA) (14 KB PDF) form to allow Health Advantage to accept claims from a third party on your behalf. Failure to complete the required authorizations may result in the rejection of your claims.
  
  
• Blanket approval will be given to clearinghouses for all of their clients after they have successfully tested and completed the Blanket Approval form. This form lists all providers/submitters for whom the clearinghouse or billing agent transmits claims.
  
  
• The clearinghouse must also complete a TPA (151 KB PDF) before migrating submissions to the new format.

If you already have an EDI submitter number...