Affinity Health Plan EDI

Affinity Health Plan EDI General Information

Affinity Health Plan EDI claims submitting information given below regard the partners sending claims for the first time and those who are participating in the Affinity provider network. Notes listed below must be taken into account.

  • Modify the tables in your billing system to include your Billing NPI and Rendering NPI on Affinity Health Plan EDI claims
  • Review the Emdeon and Affinity Health Plan Companion Guides for 837P and 837I submissions. All data elements must be properly mapped based on the EDI specifications identified for the format you are using
  • Modify the payer tables in your billing system to begin creating Affinity Health Plan EDI claims:
    • For Medical Claims for Medicaid, Child Health Plus and Essential Plan Members – Affinity’s payer ID is 13334
    • For Medical Claims for Medicare Advantage and Medicaid Advantage Members – Affinity’s payer ID is 13333
    • For Medical Claims for Qualified Health Plan Members – Affinity’s payer ID is 23334
    • For Behavioral Health Claims for All Members – Affinity’s payer ID is 43324 and our Plan ID (SBR03) is 0009
  • Submit your EDI claims file to Emdeon, the Affinity Health Plan EDI clearinghouse
  • Reconcile Affinity Health Plan EDI claim submissions by reviewing claim reports and verifying the claim status codes provided by Emdeon or your vendor to verify that all claims transmitted to Emdeon are processed and received by Affinity Health Plan. Also, review Remittance Advice provided by Affinity for claims submitted electronically to verify that claims transmitted to Emdeon have been successfully processed by Affinity.

If you are submitting electronic claims to Affinity for the first time and you are not participating in the Affinity provider network, you should complete the Non-Participating Provider Verification Form and return to Affinity via fax at the fax number located on the form. When Affinity Health Plan have received your information, they will set-up your file in the core system so that Affinity Health Plan may process your claims. If you are not registered in Affinity Health Plan EDI system, the company will not be able to identify your provider information and your claims will be rejected.

Once Affinity Health Plan have your file established, please follow the steps above in the post to submit your EDI claims.


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