Help for EDI Transaction Application To Create A New Trading Partner
Last Updated: 01/03/2005
 
Submitter Information
The person completing this form is referred to as the submitter.  Please only fill in this information with the accurate Submitter information.
 
Trading Partner Information
Trading Partner Information is required to submit this application.  Please fill out each required piece of information.  When creating a new Trading Partner the information contained in this section to be relevant to Trading Partner you are creating. 
 
Trading Partner Type
This is a required section that you must complete to submit this form.  Please make sure that you select the appropriate Trading Partner Type based on your area of business.  Based upon the Trading Partner Type that you select, you will be required to select only those Transactions that are associated to that type.

Professional Provider - Any individual or group Provider who submits professional claims or other EDI transactions.

Institutional Provider - Any individual or group Provider who submits facility claims or other EDI transactions.

Billing Service-Professional - Any entity that submits professional claims or other transactions on behalf of a provider.

Billing Service-Institutional - Any entity that submits institutional claims or other transactions on behalf of an institutional provider/facility.

Clearinghouse-Professional - Any entity that submits professional claims or other transactions on behalf of a provider.

Clearinghouse Institutional - Any entity that submits institutional claims or other transactions on behalf of an institutional provider/facility.

Software Vendor/Developer - Any entity that creates software used to conduct electronic commerce through electronic claims or other HIPAA-related transactions
 
Provider Information
When creating a new Trading Partner you can either add individual providers or you can copy providers from an existing Trading Partner.  

Adding Individual Providers:

  • Highmark Billing Provider Number and the Highmark Billing Provider Name are required for each provider you wish to add
  • You have the ability to add Electronic Remittance Advice(ERA) for each individual provider you add

Copying Providers from an Existing Trading Partner:

  • You must have an Existing Trading Partner Number that has providers attached to it
  • You must provide the number and name of the Existing Trading Partner
  • You can elect to transfer the Electronic Remittance Advice(ERA) to the new Trading Partner

After your Trading Partner is setup you may add additional providers at any time by using the EDI Application To Add Providers.
 
Transactions
When you selected the Trading Partner Type the Transactions associated to that type became available for your selection.  Please select the Transactions that you will be using at Highmark.  If you are unsure of the Transactions that you want to use or can use, please contact your Software Vendor to determine those Transactions.  Please Note: Only a Software Vendor may have both Professional and Institutional Transactions.  For a description of the Transactions please see below

 
837 - Transaction used to submit health care claims and encounters to payers.
835 - Health care payment to provider (with remittance advice) transaction.
278 - Health care services review request transaction. The 278 transaction is used to transmit health care service referral information between health care providers and health plans. It is also used to obtain authorization for certain health care services from a health plan.
276/277 - Health care claim status request and response transactions.
270/271 - Health care eligibility/benefit inquiry and response transactions.
277 claim acknowledgment- Claim status response. Used as the second response to receiving the 837. The 277 claim acknowledgement is used to indicate to the provider which claims in an 837 batch were received electronically but not yet accepted into the adjudication system, which were accepted into the adjudication system, and which claims were rejected before entering the adjudication system.
Transaction Listing
837 835 278 276/277 270/271
Highmark(54771) X X X X X
Highmark Vision(54771V) X X X X X
Independence Blue Cross Related Payers(54704) X X N/A X N/A


Please Note: The following additional payers and transactions are received along with the selection of Independence Blue Cross (54704)

AmeriHealth Administrators(54763)XXN/AXN/A
AmeriHealth NJ Non-HMO(60061)XXN/AXN/A
AmeriHealth DE Non-HMO(93688)XXN/AXN/A
Keystone Health Plan East(95056)XN/AN/AXN/A
AmeriHealth HMO(95044)XN/AN/AXN/A
IBC-Generated ERA(IBCERA)N/AXN/AN/AN/A
Transmission Mode
This is a required section to submit the form.  Based on the way that you will submit your Transactions to Highmark please select FTP/Internet.  See below for a definition of each.
Asynchronous - not synchronized. The bits constituting each character are transmitted at a fixed rate, but pauses between characters can be of any duration. Information is transferred one discrete character at a time and is delineated by a start and stop indicator at the beginning and end of the character. *This transmission mode is slower than FTP.
FTP (File Transfer Protocol) - The Internet standard high-level protocol for transferring files from one computer to another. It's a Protocol that allows users to quickly transfer text and binary files to and from a distant or local PC, list directories, delete and rename files on the foreign host, and perform wildcard transfers between hosts.
 
Unsolicited 277 Claims Acknowledgement
The 277 Claims Acknowledgement Transaction is provided to each Trading Partner that submits 837 transactions as a default claims acknowledgement response. To receive a “printable” 277 Claims Acknowledgement Report, in addition to the standard 277 transactions, you must check the box provided.

If you are not sure if your software can accept the "printable" 277 Claims Acknowledgement Report, please check with your software vendor or billing service.
 
Software Vendor Information
The only required field in this section is the Vendor Name.  Please make sure to supply Highmark with your current Software Vendor so that we may determine if you are capable of submitting Production files or Test. 
 
Validator Testing
If you would like to participate in testing please click on the checkbox and fill out the required information.
 
Acceptance
You must agree to the terms and conditions based upon your Trading Partner Type for the form to be submitted.  If you do not agree to the terms and conditions you will not be able to continue with the submission of this form.






Help to Delete a Provider from an Existing Trading Partner
Last Updated: 01/03/2005
Purpose: To delete a Provider from an existing Trading Partner
Delete Information
To complete this form you provide information in each of the fields shown.  If you do not complete one of the fields you will not be able to submit the form.  Your provider will deleted within 5 business days.  Please provide a valid reason for the deletion of the provider from the Trading Partner.






Help to Delete a Trading Partner
Last Updated: 01/03/2005
Purpose: To delete a Trading Partner that is a duplicate, inactive or incorrect.
Trading Partner Information
To complete this form you must provider information in each of the fields shown.  If you do not complete one of the fields you will not be ale to submit the form.  Your Trading Partner will be deleted within 5 business days.  Please provide a valid reason for the deletion of the Trading Partner.






Help for Requesting Trading Partner be Moved to Production
Purpose: To request a Trading Partner who has an approved Software Vendor be given the ability to submit production transactions
Trading Partner Information
Each field in this section is required.  If you do not fill out one of the fields you will not be able to submit the form. 
Software Information
Please complete both of the fields in this section.  Due to some Software Vendors having multiple software packages we require that you provide your Software Name as well as the Vendor.
Please provide any comments in regards to the move to production.