Affinity Health Plan EDI Claim Submission

Affinity Health Plan EDI Claim Submission Requirements and Guidelines

Affinity Health Plan EDI Claim information, unique to Affinity Health Plan claims, must be provided and properly formatted in the EDI file. The guidelines given in this blog and the previous one must be carefully studied by the partners before sending EDI claims to Affinity Health Plan.  Affinity Health Plan EDI Claim guides declare several formats that are accepted by Affinity Health Plan EDI clearinghouse (Emdeon) for EDI claim submission:

• ANSI X12 837 4010 (HIPAA standard submission format. There are two types: 837I for institutional claims and 837P for professional claims)
• NSF + (National Standard Format was the accepted standard before the ANSI X12 837 format was created)
• MCDS (Emdeon’s proprietary format for professional claims)
• HCDS + (Emdeon’s proprietary format for institutional claims).

837 Professional (837P)

837 Institutional (837I)

Other than the 4010A1, the formats listed below (NSF+ and HCDS+) are the only other formats for submitting claims with NPIs to the Emdeon clearinghouse. Affinity Health Plan urges providers to use the 4010A1 format for their electronic claims submissions.

NSF + (National Standard Format)

HCDS + (Institutional)