EDI Claims

Health Partners General Requirements for the Electronic Claims Submission Process (837 Professional Claims)

Find below Health Partners Plans general guidelines for 837 Professional Claims Submission.

  • Only loops, segments, and data elements valid for the HIPAA 837 Professional (005010X222A1) Technical Report Type 3 will be translated. Deviating from the Technical Report Type 3 and submitting invalid data will cause files to be rejected.
  • Only one transaction type per transmission.
  • The delimiters which Health Partners Plans will accept are listed below. The following characters must not be used within the data content of the 837P:
    • Data Element = * (Asterisk)
    • Segment = ~ (Tilde)
    • Component/Element = : (Colon)
  • No more than 5,000 claims should be submitted by any provider at one time.
  • WebMD/Emdeon Business Services will perform HIPAA compliance checking for all transactions received. If the transaction fails compliance checking, a “997 Functional Acknowledgement – Reject” will be generated and transmitted to the provider. The provider will be expected to correct the data and immediately retransmit the transaction.
  • Rejected claims must be resubmitted within 180 days of the original date of service.
  • Negative values submitted in the following fields will not be processed and will result in the claim being rejected: Total Claim Charge Amount (2300 Loop, CLM02), Patient Amount Paid (2300 Loop, AMT02), Patient Weight (2300 and 2400 Loop, CR102), Transport Distance (2300 and 2400 Loop, CR106), Payer Paid Amount (2320 Loop, AMT02), Allowed Amount (2320 Loop, AMT02), Line Item Charge Amount (2400 Loop, SV102), Service Unit Count (2400 Loop, SV104), Total Purchased Service Amount (2300 Loop, AMT02), and Purchased Service Charge Amount (2400 Loop, PS102).

Health Partners Plans suggest retrieval of the ANSI 997 Functional Acknowledgment files on the first business day after the claim file is submitted, but no later than five days after the file submission. Health Partners Plans Claims Technical Support is available Monday through Friday, 9:00 a.m. to 5:00 p.m. (EST).

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

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