AHCCCS EDI FAQs (Frequently Asked Questions regarding EDI communication)

Following the series of posts for AHCCCS EDI partners, find below Part 1 Frequently Asked Questions regarding EDI communication.

Q: What are the different types of batch EDI transactions AHCCCS exchanges?

A: The following are the EDI transactions AHCCCS exchanges:
• 270 005010X279A1 Eligibility, Coverage, or Benefit Inquiry
• 271 005010X279A1 Eligibility, Coverage, or Benefit Information
• 275 005010X210 Additional Information to Support a Health Care Claim or Encounter (275)
• 276 005010X212 Health Care Claim Status Request
• 277 005010X212 Health Care Claim Status Response
• 277CA* 005010X214 Health Care Claim Acknowledgement
• 277U 003070X070 Health Care Payer Unsolicited Claim Status
• 278 005010X217 Health Care Services Request/Response
• 820 005010X218 Payroll Deducted and Other Group Premium Payment for Insurance
• 824* 005010 Application Reporting for Insurance
• 834 005010X220A1 Benefit Enrollment and Maintenance
• 835 005010X221A1 Health Care Claim Payment/Advice
• 837P 005010X222A1 Health Care Claim: Professional
• 837I 005010X223A2 Health Care Claim: Institutional
• 837D 005010X224A2 Health Care Claim: Dental
• 999* 005010x231A1 Implementation Acknowledgement for Health Care Insurance
• NCPDP PAH 2.2 – report post adjudicated pharmacy encounters
• TA1*

AHCCCS does not provide a Companion Guide for these transactions as they follow what is identified in the TR3.

Q: Does AHCCCS provide Real-Time 270/271 processing?

A: AHCCCS has opted to contract with the following vendors to provide the real-time 270/271 transactions:
• Dorado Systems, Inc.
• Emdeon (Change Healthcare)
• Passport Health Communications, Inc.
• TransUnion Healthcare, Inc.
Q: Does AHCCCS provide Real-Time 276/277 processing?
A: AHCCCS is in the process of determining the best system approach using the limited resources available and have no update as it pertains to real-time 276/277 transactions to provide at this time. It is AHCCCS’ intent to have the real-time 276/277 exchanged with the same vendors outlined above.
Q: How do I get setup with AHCCCS so our office/clearinghouse (if applicable) can begin exchanging electronic transactions?
A: You will need to email EDICustomerSupport@azahcccs.gov and provide the following information:
• Customer Name
• Organization Name
• Customer Email Address
• Customer Telephone Number
• 6-digit AHCCCS Provider ID and/or NPI
• Clearinghouse (if applicable)

As long as the clearinghouse is an AHCCCS certified trading partner for Electronic Claim Submission (ECS) or 837 transaction, they can submit electronic claims for any AHCCCS registered provider; there is no additional ECS setup requirement for the provider or the clearinghouse to fulfill as far as AHCCCS is concerned.

To learn more about EDI and become a certified  EDI Professional please visit our course schedule page.

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