We support all HIPAA-compliant electronic transactions. As a component of The Health Insurance Portability and Accountability Act (HIPAA), it is required that all medical records, billing and patient accounts meet consistent documentation, handling and privacy standards.
If you are interested in submitting Electronic Data Interchange (EDI) transactions for member eligibility, claim submission, claim acknowledgement, and/or claim status, download and complete our EDI Setup Form (PDF). Complete the EDI setup form by filling it out electronically and saving the file. Once completed, send the PDF as an attachment in an email to email@example.com.
EDI setup form 39113 (PDF)
|EDI Transaction Type||EDI Transaction Number||Connection Setup||Alternative to EDI|
|Eligibility Inquiry and Response||270/271||Real-time connection available through our Clearinghouse Smart Data Solutions.||Benefit Eligibility can be confirmed real-time through our Provider Portal.|
|Claim Submission||837||Claim Submission and Acknowledgement responses through our Clearinghouse Smart Data Solutions.||We have partnered with Smart Data Solutions to offer claim submissions by manually keying in the claim information and submitting them electronically through the Smart Data Stream Clearinghouse Portal. There is no cost for providers or trading partners who submit claims using this portal. Rejected claims can also be corrected and resubmitted through this portal. Register by contacting Smart Data Solutions at 1-855-297-4436 or online through the Account Creation Page for Payer Enrollments webpage.|
|Claim Acknowledgement||277CA||Claim Submission and Acknowledgement responses through our Clearinghouse Smart Data Solutions.||Claim Acknowledgment (for if claims were accepted or rejected for adjudication) can be confirmed through our Confirmation Reports Portal.|
|Claims Status Inquiry and Response||276/277||Real-time connection available through our Clearinghouse Smart Data Solutions.||Claim status can be confirmed real-time through our Provider Portal.|
|Payment/Advice (exclamation of payment)||835||We have partnered with Change Healthcare for the exchange of both paper explanation of payments and checks as well as electronic remittance advices and electronic funds transfers. Please visit Change Healthcare's Payer Enrollment Services webpage.||A provider can view and download a copy of the Explanation of Payment by Claim ID through our Provider Portal.|
First weekend of every month:
Third weekend of every month:
If you have any questions, contact the EDI Support Team for Payer ID 39113 at firstname.lastname@example.org.