Claim Submission Via Electronic Data Interchange (OHCA)
EDI is a way for providers to check eligibility on a larger scale than the previously listed options. Providers purchase third-party, HIPAA compliant software used to send a 270 transaction with their search criteria and receive a 271 response, which provides eligibility information. A 271 will provide information on the different programs the member is eligible for, as well as any TPL or Medicare information.
There are three main methods for submitting claims to the OHCA: paper (primarily special batch), direct data entry (DDE) via the SoonerCare Provider Portal and through electronic data interchange (EDI) batch transactions. Below is a paper-to-electronic conversion table for the different claim submission types.
To learn more about EDI and become a certified EDI Professional, please visit our course schedule page.