Electronic Claim Transaction

Electronic Data Interchange (EDI) is Available to all Providers

ediHave you completed the requirements to submit electronic claims to the Health Care District? If not, make it a priority today. Electronically submitted claims can be processed faster with information submitted directly from you.

The Health Care District has a relationship with Availity, L.L.C and Emdeon. We only accept claims from these two services and encourage providers and billing services that do not have a clearinghouse to choose one of these businesses.

Medical claim clearinghouses provide various services that may include:

  1. Routing health care claims to the appropriate destination.
  2. Validating health care claims before submitting to the receiver.

For more information on electronic claim submission with the Health Care District, please review the documents provided below:

  • 837P Companion guide (PDF 248.5KB) contains information to get you started with our EDI program. Please review the guide for current business requirements, enrollment procedures, enrollment forms and important billing guidelines to facilitate fast and smooth claim submission.
  • 837I Companion guide (PDF 293.2KB) contains information to get you started with our EDI program. Please review the guide for current business requirements, enrollment procedures, enrollment forms and important billing guidelines to facilitate fast and smooth claim submission.
  • Glossary of terms (PDF 39.3KB) to assist users in understanding Electronic Claim Transactions.

An established set of requirements must be met before electronic claims can be submitted for payment. These requirements include:

  1. Complete an Electronic Claims Enrollment Form (PDF 72.7KB) available in the 837P Companion Guide or an Electronic Claims Enrollment Form (PDF 72.7KB) available in the 837I Companion Guide.
  2. Establish a business relationship with Emdeon, Availity or a clearinghouse that routes claims through them.

For EDI enrollment questions, please contact our EDI resource staff at (561) 804-5759.

NOTE: All health care claims submitted to the Health Care District electronically must be ANSI 837 compliant. When filling out the application, please be sure you use your appropriate billing address as electronic claims can be automatically denied if the is an address mismatch.

For Providers Enrolled in the EDI Program

Requirements and Corrective Action

For provider who are enrolled in the EDI Program, you are required to provide immediate notice to the program when the following items occur:

  • Service Address Changes
  • Tax Identification Number (TIN) Changes
  • NPI Changes
  • Individual or Group NPI changes that no longer match enrollment forms on record

Failure to properly notify the Health Care District of service address changes, TIN changes, NPI changes or submissions that do not match provider enrollment forms, will lead to corrective action steps. Corrective action includes formal notification by the program of submissions that do not match enrollment forms on record. Three consecutive notices for the same error may lead to disenrollment from the EDI program.

Availity - Member ID Change

If you or your clearinghouse submits claims electronically through Availity, please note there has been a change in the required format for the member identification number. Claims submitted with the incorrect format (i.e. dashes, asterisk, etc.), will be rejected by Availity with the following rejection reason “The member ID (Loop 2010BA, Segment NM109) must be a minimum of six (6) numeric digits”.

 

Free viewers are required for some of the attached documents.  They can be downloaded by clicking on the icons below.

acrobat-reader-iconwinzip-icon word-icon excel-icon powerpoint-icon windows-media-player

Back to Top