Submit a Claim

Submit a Claim

We believe providers deserve to be paid accurately and on time for the important role they play in their patient’s overall health. We create efficient, streamlined claims submission process to make that happen, and support it all with a strong customer service team that is ready to serve you. 

When it comes to processing claims, start by checking 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:

1. the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information, 
2. the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; and 
3. 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 

1-800-527-8133, Option 2 

www.relayhealth.com

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 to 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.  

Additional Information

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
1-877-469-3263
http://transact.emdeon.com/

ABS Contact Information

Email: ABS EDI Support

ABS Paper Claim Submission

Please refer to the claims submission address on the member ID card.