EDI Health Partners

EDI Health Partners: Basis Provider Requirements

EDI Health Partners program requires all vendors use Electronic Data Interchange (EDI) – sending and receiving of information using computer technology. Any standard business document that one company would exchange with another; such as a purchase order, invoice, shipping schedule, inventory inquiry, and claim submission; can be exchanged via EDI between the two parties, or trading partners.

EDI Health Partners – Benefits

  • Reduced administrative costs
  • Higher claim acceptance rates
  • Data moves faster and with greater accuracy
  • Increased productivity
  • Audit trail of claims submissions
  • Elimination of paper documents
  • Elimination of labor-intensive tasks, such as data entry
  • Greater accuracy of information

EDI Health Partners: Electronic Claims Processing

You can have speed, convenience and lower administrative costs through Electronic Data Interchange (EDI), or electronic claims processing. Health Partners Plans utilizes the Emdeon Transaction Services, also known as NEIC, ENVOY, or WebMD ENVOY claims clearinghouse.

  • Contact your billing software vendor and request that your EDI Health Partners, KidzPartners or Health Partners Medicare claims be submitted through the Emdeon claims clearinghouse, or
  • Direct your current EDI clearinghouse to forward your claims to Emdeon.

For all claims (CMS-1500/837P and UB-04/837I) submitted electronically through the Emdeon clearinghouse, Health Partners Plans can electronically return a detailed status for each claim. The status message will show which claims were accepted, rejected and/or pending, and provide the amount paid on the submitted claim once it has been finalized.

If you are an Emdeon submitter and you do not have the ability to receive Emdeon claims status, please contact your billing software vendor for more information.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA), requires that all transactions and code sets be in HIPAA standard format (ASCX12N). HIPAA Connect is your primary resource for information regarding Health Partners Plans Health Insurance Portability and Accountability Act of 1996 (HIPAA) Administrative Simplification implementation.

If you are not submitting your own claims, please forward the guide to your clearinghouse or whoever else is responsible for your transactions.

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