South Carolina EDI Technical Communications User's Manual

EDI Gateway Technical
Communications User’s
Manual

Version 3.8

August 2008

Technical Communications User’s Manual

Disclaimer

We publish this manual for informational use only. We periodically make changes to the
information in this manual. We will incorporate these changes in new editions of this publication.
EDI Gateway may make improvements and/or changes to this publication at any time.

Page 1 BlueCross BlueShield of South Carolina EDI Gateway

Technical Communications User’s Manual

Revision Log

We have recorded revision numbers, version numbers, dates and brief descriptions of the
purpose for revision below. As we make revisions, we will number them consecutively beginning
with 1. Following a thorough review of all material included in a revision, please discontinue use
of or destroy all prior versions of this document.

Revision

Number

1 2.00 Feb 2003
2 2.01 May 2003 X12N version 4010A1 updates, EDIG proprietary report

3 2.02 July 2003 Update to the enrollment form, FTP instructions, connectivity

4 2.03 August 2003 Change to inbound envelope instructions.
5 2.04 September 2003 Changes to the enrollment form to require vendors to identify

6 3.0 May 2005 New release
7 3.1 July 2005 Name change to BlueChoice® HealthPlan (formerly Companion

8 3.2 February 2006 Changes to reflect test environment schedule. Document

9 3.3 May 2006 Added After Hours/On Call fields on enrollment form. Added info

10 3.4 June 2006 Changed Sunday connectivity testing time to after 10:00pm ET.

11 3.5 March 2007 Changed name of TPA Employee Benefit Services to Employee

12 3.6 March 2008 X12N 276 transaction has LU6.2 /TCPIP connectivity available.

13 3.7 May 2008 Added column in BlueCross EDIG Trading Partner Enrollment

14 3.8 August 2008 Changed FTP Dial-up IP address for production and test.

Please Note: The EDI Gateway Technical Communications User’s Manual is subject to change
as we continue to enhance our services to you. This manual is available via the Internet on the
SouthCarolinaBlues.com Web site in the HIPAA Critical Center. Please follow this link --

http://www.southcarolinablues.com/HIPAA Critical Center -- and look for this manual under the

“Technical Information” heading.
If you have any questions or concerns with this manual, please contact

[e-mail].

BlueChoice HealthPlan is a wholly owned subsidiary of BlueCross BlueShield of South Carolina. Both are
independent licensees of the Blue Cross and Blue Shield Association.

Version Date Description

changes, FTP telephone number change.
options, NDM instructions, changes to the additional information

for trading partners page

provider customers.

Healthcare), Payer list update, TCPIP and LU6.2 Connectivity
options added.

conversion to PDF format, removal of verbiage related to prior
MS Word format, added hyperlink to enrollment form, added
fields for clearinghouse/software vendor entry to Thumbs Up
Certified Vendor list, removed NCPDP information and changed
footer.

to SFTP, VPN and NDM connectivity about 1000 byte file length.
Added info to SFTP about SSH2 / SecureFX and Sunday testing
of connectivity.

Date in footer removed since it’s on cover and kept current in
revision log. Added fax number and after hours TSC phone
number.

Benefit Administrators. Changed BLKSIZE to 27000. Removed
after hours TSC phone number. Changed processing time for
SFTP to 7 – 14 business days. Changed TIN for Instil. Added
Health Net

Added Humana Veteran Healthcare Services to Receiver ID
listing.

Form for NPI #. Removed State and Add/Change/Remove
columns.

®

TIN. Updated address for Palmetto GBA.

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Technical Communications User’s Manual

Table of Contents

About Us / Introduction..............................................................................................................4

Trading Partner Enrollment .......................................................................................................5

Trading Partner Enrollment Form..............................................................................................5

Enrollment Testing Procedures.................................................................................................7

Payer Testing............................................................................................................................8

Transition from Test to Production Status.................................................................................8

Privacy.........................................................................................................................................9

Connectivity ..............................................................................................................................10

GP Net.....................................................................................................................................11

Overview..............................................................................................................................11

Dial-up REDI........................................................................................................................12

Initial Set Up Using Asynchronous Dial-up ......................................................................12

Server Connection Using Asynchronous Dial-up.............................................................13

Log In and User Validation...............................................................................................14

Messages.........................................................................................................................15

Main Menu .......................................................................................................................15

Upload a File....................................................................................................................16

Download a Response.....................................................................................................17

List Files In Mailbox for X12 Transactions .......................................................................18

Dial-up FTP..........................................................................................................................20

Logging onto GPNet Using FTP.......................................................................................20

Uploading Files Using FTP ..............................................................................................22

Downloading Files Using FTP..........................................................................................23

Secure File Transfer Protocol (SFTP).....................................................................................24

Virtual Private Network (VPN).................................................................................................24

Connect Direct: NDM .............................................................................................................. 25

LU6.2.......................................................................................................................................25

TCPIP......................................................................................................................................25

X12 Transactions......................................................................................................................26

EDIG Inbound Response Matrix..............................................................................................27

EDIG Specifications for Enveloping X12 Transactions ...........................................................29

X12 Inbound Transactions...................................................................................................29

X12 Outbound Transactions................................................................................................30

EDIG Proprietary Claim Responses........................................................................................31

Claim Response Layout – Professional...............................................................................31

Claim Response Layout – Dental........................................................................................35

Claim Response Layout – Institutional ................................................................................39

Claim Submission Summary Report....................................................................................42

Error Claim Summary Report .............................................................................................. 44

Additional Information for Trading Partners..........................................................................46

Glossary of Terms and Abbreviations....................................................................................47

Appendix....................................................................................................................................48

BlueCross EDIG Trading Partner Enrollment Form

ASC X12N Transactions .........................................................................................................

Page 3 BlueCross BlueShield of South Carolina EDI Gateway

49

Technical Communications User’s Manual

About Us / Introduction

Welcome to the BlueCross BlueShield of South Carolina EDI Gateway. This document offers
instructions for submitting electronic transmissions to the BlueCross commercial lines of
business and PGBA TRICARE. It includes information about our trading partner enrollment
process, gateway connectivity options and HIPAA transactions specifics.

EDI Gateway processes electronic transactions for the following BlueCross subsidiaries:
Healthcare Payers

BlueCross BlueShield of South Carolina
BlueChoice
Instil Health
PGBA, LLC (TRICARE)

HealthPlan

Third Party Administrators
Carolina Benefit Administrators
Employee Benefit Administrators
Planned Administrators, Incorporated
Thomas H. Cooper & Company

Companion Companies
Companion Life Insurance Company

EDI Gateway’s production environment is accessible 24 hours a day, seven days a week, with
the exception of weekly maintenance performed Sundays between 3:00 p.m. – 10:00 p.m. EDI
Gateway’s test environment is accessible Monday through Saturday 5:00 a.m. – 10:00 p.m.

We send notifications of EDI Gateway outages to trading partners via e-mail. 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 Technology Support Center at 803-736-5980 or 1-800-868-2505 with
questions or to report problems.

Additional information is available via the Internet at
BlueCros s ’ l in e s o f b u sin e ss and

www.SouthCarolinaBlues.com for

www.MyTRICARE.com for PGBA, LLC (TRICARE).

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Technical Communications User’s Manual

Trading Partner Enrollment

Trading Partner Enrollment Form

The purpose of the BlueCross 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 can be found at the back of this manual in the Appendix and is also
available via the Internet at

complete enrollment forms electronically. 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 after you have
completed the form.

If you are a prospective BlueCross commercial, BlueChoice HealthPlan, or Instil Health payer
trading partner, print and mail a hard copy of the completed form to:

BlueCross BlueShield of South Carolina
Technology Support Center: EDI Enrollment
I-20 at Alpine Road, AA-E05
Columbia, SC 29219

If you are a prospective PGBA LLC (TRICARE) trading partner, e-mail the completed form to

[e-mail]. Or, you can fax a copy to [phone] or print and mail a hard

copy to:
Palmetto GBA

Attention: EDIG Operations, AG-280
2300 Springdale Drive, Building One
Camden, SC 29020-1728

EDIG Operations will acknowledge receipt of your enrollment form via e-mail within four business
days.

This table will help trading partners complete the enrollment form:

Form Field Name Instructions for Field Completion Req.

Date
Action Requested:

New Trading Partner

ID

Change
Cancel

Trading Partner Name
Trading Partner ID

http://www.southcarolinablues.com/enrollmentform.You should

Enter today’s date.
Indicate the action to be taken on the enrollment form.

Note: Depending on the requested action, different fields of

this form are required. These 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.

Enter the name of the entity that will be submitting/receiving
electronic transactions with BlueCross EDIG.

The Trading Partner ID is assigned by BlueCross EDIG to
identify trading partners to our system.

1 2 3

1
2
3

1 2 3

2 3

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Technical Communications User’s Manual

Form Field Name Instructions for Field Completion Req.

Federal Tax ID #

Enter the trading partner’s Federal Tax Identification Number.
Select the type of primary business the trading partner

Type of Business

conducts. If you check “O t h e r ,” i n d i ca t e th e t yp e o f b u s in e ss
on the line provided.

Line of Business
Start Date

Check one box per enrollment form indicating if transactions
are BlueCross Commercial or TRICARE.

Indicate, in mm/dd/ccyy format, the date the trading partner
plans to begin transaction testing with BlueCross EDIG.

If you are using this form to cancel an account, indicate, in

End Date

mm/dd/ccyy format, the date the trading partner intends to
terminate its trading partner account.
If you wish your files to be downloaded in a compressed

Compression

format, check PKZIP or UNIX. If not, check No
Compression.

Check the preferred communication method. If ASYNC dial-

Protocol

up is checked, then specify the product. If Other is checked,
please specify.

Enter the trading partner’s complete address (including

Service Address

street, city, state and ZIP) that is the physical location for
your business.
If different from the service address, enter the trading

Billing Address

partner’s billing (or mailing) address (including street, city,
state and ZIP).
The name, e-mail address, telephone number and fax

Primary Contact
Information

number of the trading partner’s primary contact. This is the
person BlueCross EDIG will contact if there are questions
regarding the enrollment or future questions about the
account.

The name, e-mail address, telephone number and fax
Technical Contact
Information

number of the trading partner’s technical contact. This is the

person BlueCross EDIG will contact if there are technical

questions or problems.

The name, e-mail address, telephone number and fax
After Hours Technical
Contact Information

number of the trading partner’s after hours technical contact.

This is the person BlueCross EDIG will contact if there are

technical questions or problems after normal business hours.

The name, e-mail address, telephone number and fax
On-Call Technical

Contact Information

number of the trading partner’s on-call technical contact. This

is the person BlueCross EDIG will contact if there are

technical questions or problems after normal business hours

and is unable to contact the After Hours Technical Contact.
Transaction Volume

Estimates

Mark yes (Y) or no (N) for each mode. If you mar k yes, ind icate

the average number of transactions y ou anticipat e submit ting

each week.

1

1

1
1

3

1

1

1 2

1 2

1 2

1 2

1 2

1 2

1

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Technical Communications User’s Manual

Enrollment Testing Procedures

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, compliance (for HIPAA X12N transactions) and front-end payer
edits when available in the test environment.

The following must be performed for each different transaction type that a trading partner is
approved to submit to EDIG.

Test Plan

Connectivity

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 test to production

transition that considers volume testing and transaction acceptance

ratios.

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

Data Integrity

Acknowledgement /
Response
Transactions

Results Analysis

EDIG will validate approved trading partners are submitting

transactions allowed per our enrollment applications.

When HIPAA X12 transactions are transmitted, data integrity is

determined by X12 and HIPAA Implementation Guide (IG)

compliance edits performed by EDIG’s translator. Testing cannot

progress until a trading partner’s data receives no compliance edit

errors. EDIG expects there may be an occasional situation where a

trading partner’s translator IG compliance interpretation differs from

our translator. We will work with our trading partner to resolve such

differences on an individual basis.

EDIG returns transmission acknowledgement and edit result

response transactions from this process. The trading partner should

correct transactions reported as errors and resubmit them.

Trading partners must demonstrate the ability to receive

acknowledgement and response transactions (see page 36 & 37)

from EDIG. EDIG expects trading partners will also implement

balancing or reconciliation processes and report transmission

discrepancies to us immediately.

EDIG and the trading partner will review acknowledgement and

response transactions for consistency with the predefined expected

results.

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Technical Communications User’s Manual

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.

Transition from Test to Production Status

When test results have satisfied the test plan, 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.

Page 8 BlueCross BlueShield of South Carolina EDI Gateway

Technical Communications User’s Manual

Privacy

EDIG and our trading partners are committed to protecting the privacy of patient information.
When sending sensitive data (i.e., names, patient ID numbers, date of birth, etc.) via the Internet
to EDIG Operations for research, please zip and password protect files.

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Technical Communications User’s Manual

Connectivity
Trading partners may choose to connect with EDI Gateway via dial-up (GP Net) interface,
secure high-speed data transfer, SNA and IP access.

Dial-up interfaces available are:

• REDI (Asynchronous Dialup)

• FTP (File Transfer Protocol Dialup)

Secured high speed data transfer methods available are:

• SFTP (Secure FTP utilizing SecureFx)

• VPN (Virtual Private Network)

• NDM (Connect: Direct Network Data Mover)

SNA interface available is:

• LU6.2

IP access:

• TCPIP

The following 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 SNA NDM Proprietary
LU6.2 SNA Proprietary over SNA/AGNS
DIAL-UP REDI Proprietary transfer via X, Y or Z modem
DIAL-UP FTP Proprietary FTP
IP TCPIP Proprietary IP connection via AGNS

The following table lists connectivity options available for certain transactions:

Transaction Available Connectivity Types

X12N 270

Dial-up, SFTP, NDM, VPN, LU6.2, TCPIP
X12N 276 Dial-up, SFTP, NDM, VPN, LU6.2, TCPIP
X12N 278 Dial-up, SFTP, NDM, VPN

X12N 820
X12N 834
X12N 835

Dial-up, SFTP, NDM, VPN

Dial-up, SFTP, NDM, VPN

Dial-up, SFTP, NDM, VPN
X12N 837

Dial-up, SFTP, NDM, VPN

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Technical Communications User’s Manual

GP Net

Overview

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 may select any of the protocols listed below. 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.

♦ 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 6.07

♦ HyperTerminal; Windows ’95, ’98, and NT

The settings you should verify are:

♦ Terminal emulation - VT100
♦ Parity - NONE
♦ Data Bits – 8
♦ 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 uncomp ressed files. T herefore, if you wis h t o recei v e your f iles in a compr essed 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 the following figures.

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Technical Communications User’s Manual

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 login.

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 click on OK. (Figure 1)

• 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 Phone Number message box
(Figure 2) is where you enter the GPNet
phone number, and verify your country
code, area code and modem. Complete
the following steps:

a) For Country code, 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 dropdown arrow to select

the correct modem.
e) Click OK.

Figure 1 – Connection Description Box

Figure 2 – Phone Number Message Box

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Technical Communications User’s Manual

Server Connection Using Asynchronous Dial-up

1. The connect message boxes (Figures 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

Your Location are correct (Figure 3),

click Dial.

• If you need to correct the telephone
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.

• If 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.

Figure 3 – Connection 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)

Figure 4 – Connection Message Box

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Technical Communications User’s Manual

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).

Figure 5 – GPNet Welcome/Login Screen

You must enter the ID and password in capital letters. To login:

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.

To change your password, please contact the BlueCross Technology Support Center at 1-800­868-2505 or 1-803-736-5980.

Page 14 BlueCross BlueShield of South Carolina EDI Gateway

Technical Communications User’s Manual

Messages

After the User ID and password are validated, the Message screen displays (Figure 6).

Figure 6 – GPNet Message Screen

This screen features two distinct parts:

♦ User Login information – displays information about current and previous login activity.
♦ The system-wide banner – displays important information for all trading partners.

After reading any banner messages, press ENTER to continue to the Main Menu.

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.

Figure 7 – GPNet Main Menu

Page 15 BlueCross BlueShield of South Carolina EDI Gateway