Claim Submission Process
ABS understands that providers are an integral part of our success. We believe that providing great customer service not only extends to the agents, clients and participants, but also to providers. Therefore, we ensure that your claims are paid not only accurately, but also timely.
One way that we can work together to support these efforts is through streamlining and supporting the claim submission process.
First, check the participant's ABS-issued ID card for instructions. Many PPOs require that claims are submitted directly to the PPO. If not, providers can submit claims to ABS in a number of methods:
- Through ABS’ contracted clearinghouse,
- Using other clearinghouses,
- Direct to ABS through the RelayHealth PCS portal,
- Direct FTP, or
- Paper claim form submission.
Regardless of the method of submission, ABS adheres to:
- the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information,
- the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; and
- the confidentiality provisions of the Patient Safety Rule, which protects identifiable information being used to analyze patient safety events and improve patient safety.
The following describes the claims submission options available for providers submitting claims to ABS.
Claims submission through ABS’ contracted clearinghouse-RelayHealth
ABS’ contracted clearinghouse is RelayHealth. Claims can be processed directly through RelayHealth’s Connectivity Services to ABS. For additional information in establishing a link between your office and RelayHealth you can contact them at
1800-527-8133, Option 2
Claims submission using other clearinghouses
The easiest and quickest way to submit your claims to ABS is to setup a link directly with our contracted clearinghouse-RelayHealth. If you have a current agreement with another clearinghouse, however, you can still utilize their services provided they either have an established relationship with RelayHealth or be able to push your files to another clearinghouse that does have a relationship with RelayHealth. It is possible to have two or more clearinghouses linked where one has a relationship with another, who has a relationship with RelayHealth.
To determine if your clearinghouse has a relationship with RelayHealth please contact RelayHealth at the telephone number listed above or your own clearinghouse.
Claims submission direct to ABS through the RelayHealth PCS portal
ABS has a direct portal connection through the RelayHealth PCS Portal. The portal is administered by RelayHealth, but is a direct link to ABS. We recommend that trading partners transmitting claim volumes larger than 200 claims daily utilize the PCS Portal. Partners that wish to use the portal should contact ABS - EDI Support.
Claims submission using a direct FTP
ABS has the capability to either host a FTP or connect to a client-hosted FTP site. While we have the ability to support this method, it is not recommended to utilize this approach because of the additional features offered through utilizing a clearinghouse. If you choose this method, you must contact ABS EDI Support so that we can implement the proper protocols to support your FTP needs.
Paper form claim submission
ABS also accepts and processes claims provided to us in a paper form. ABS accepts claims in UB-92 (institutional) and CMS-1500 (professional) forms. The submission of claims in paper form is not recommended due the higher error ratio associated with incorrect, missing or unreadable characters. Providers whose only option is to provide paper claims can arrange such submission by contacting ABS.
Implementation and Testing
ABS is committed to making your claim payment process as easy and error free as possible. Once we determine the preferred method of data communication the next step is to verify and test the process.
We have a comprehensive implementation and testing plan and Guide, which will include everything you need for submitting claims to ABS as well as information on the electronic acknowledgment process.
ABS File Requirements
- ABS can accept ANSI X12 version 5010 for all 837 transaction sets (institutional, professional and dental)
- ABS processes ANSI X12 837 institutional professional files. We verify all inbound x12 file to WEDI SNIP Level2. Information on formatting can be found at www.wpc-edi.com .
- ABS requests that files be submitted with no greater that 500 claims per file.
- No more than one (1) ISA/IEA per file
- Each file can contain more that one GE/GS envelope
- Individual claims can be wrapped in their own GE/GS envelope.
Provider Explanations of Benefits
ABS allows the option for providers to receive their Explanations of Benefits (EOBs) in either electronic (EDI X12) or paper form.
Paper EOBs are provided automatically with each claim. Providers wishing to receive electronic EOBs, however, will need to arrange for that service by contacting Emdeon to arrange for electronic delivery:
Emdeon Business Services (formerly WebMD)
One Century Place
26 Century Blvd, Suite 601
Nashville, TN 37214
ABS Contact Information
ABS EDI Support
ABS Paper Claim Submission
P.O. Box 37506, Oak Park, MI 48237-0506