EDI Health Care Insurance

EDI Health Care Insurance Requirements For Unity Health Insurance Vendors

EDI Health Care Insurance refers to Electronic Claims Submission. It allows medical providers and other parties involved in EDI Health Care Insurance to send and receive health care claims information. Unity supports all HIPAA-compliant electronic transactions.
You can submit EDI Health Care Insurance claims to Unity one of two ways:

  • Directly to Unity
  • Or, through a third-party clearinghouse
Scheduled maintenance downtime takes place the third Thursday of each month between 2 a.m. and 4 a.m. During this time, you will not be able to perform Benefit / Eligibility (270/271 v5010 EDI) and Claim status (276/277 v5010 EDI) inquiries. Downtimes do not occur on holidays unless an emergency or scheduled maintenance occurs.

Electronic Remittance Advice (ERA / 835) & Electronic Funds Transfer (EFT)

If you are a new or existing trade partner and would like to implement ERA and / or EFT with Unity you should complete the following form(s) – Authorization Agreement for Electronic Health Care Claim Payment / Advice (835) and Authorization Agreement for Electronic Fund Transfers (EFTs).

Submitting Claims through a Third-Party Clearinghouse

Unity accepts claims electronically through third-party clearing houses.  Unity uses the following EDI vendors –

  • McKesson (Relay Health) 800.527.8133
  • Netwerkes 800.765.6713
  • Change Healthcare (Formerly Emdeon, excludes ERA) 877.469.3263
  • PayerPath 877.347.6691
  • SSI Group 800.880.3032
  • G and C Clearing House 888.456.9707
  • Healthcare Data Systems 800.486.2273
  • CPSI 251.662.4078
  • ClaimLogic 405.942.9800
  • Viatrack 800.426.3385
  • Health Claims Services 608.831.1563
  • Outsource Inc 262.544.4442

Authorization Agreement For Electronic Health Care Claim Payment / Advice (835)

Once the authorization process begins, ERAs will be securely delivered to vendor designated trading partner data repository. This will include a tracing number that will tie back to your EFT (Electronic Funds Transfer) or Check payment. The following steps should be taken:

  • Step 1: Complete the ERA Authorized Agreement Form.
  • Step 2: Unity will process ERA Authorization Agreement usually within two to five business days. At the time the process is complete, your next claims payment advice will be an ERA.
  • Step 3: In order to receive your ERA after your authorization agreement has been confirmed, you must contact your vendor or clearinghouse to arrange for the delivery of the CORE-compliant ERA.

Once both originals are received, approved and signed by Unity Health Plans, one of the originals will be mailed to the vendor or clearinghouse. Then, Unity will complete one successful round of testing with this vendor or clearinghouse using the ERA claim tests for the provider seeking authorization. When this process is complete, the process is confirmed.

Leave a Reply

Your email address will not be published.

Post Navigation