EDI Claims

EDI Claims LifeWise Requirements And Guides

EDI Claims for LifeWise are accepted in electronic form either by direct submission or from selected clearinghouses.

Sending EDI Claims offers advantages:

  • Less time spent on claims preparation
  • Cost savings through prevention of loss and potential delay
  • Detailed claim acceptance and rejection reporting
  • Faster claims processing and response times
  • A professional staff available to assist you with Electronic Data Interchange (EDI) matters

LifeWise accepts both institutional and professional EDI Claims electronically. Claims may be submitted directly by the provider or through a clearinghouse or billing service providing that the submitter’s system is able to transmit claim data in ANSI- and HIPAA-compliant formats.

Professional EDI Claims – Include medical, chiropractic, vision and durable medical equipment, and alternative medicine

Institutional EDI Claims – Includes facility and hospital

Dental professional EDI Claims – Can be sent directly or through an approved clearinghouse.

Electronic Formats – ASC X12 837 (version 5010A mandated for use on 06-30-2012)

Enrollment – LifeWise requires providers/submitters to be enrolled for company EDI process.

HIPAA – LifeWise performs full-scale HIPAA editing on all claims received. Claims that do not pass HIPAA edits will be rejected back to the submitter.

Eligibility-LifeWise systems perform an upfront patient eligibility check on all claims received. Claims for which no eligibility can be found are listed as “rejected” on our Electronic Claims Transaction Report.

Be sure all code set values are current. Some of the most common HIPAA-related rejections are invalid diagnosis codes, invalid procedure codes and/or invalid code for the date of service being billed. Improperly formatted Provider Tax ID, Social Security Number (SSN) or National Provider Identifier (NPI) numbers used for billing purposes should be submitted without dashes, hyphens or spaces. The number should be properly identified as either a Federal Tax ID or SSN with the related NPI. Do not list the patient’s name as the insured, unless that is truly the case. Verify member’s ID number, spelling of insured and patient’s names, and date of birth for patient. LifeWise cannot accept two different years for the date of service on one bill. Please bill dates of service for different years separately.

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