EDI Procedure

EDI Procedure FAQs For Health Partners Plans Vendors

EDI Procedure frequently asked questions and answers given below will help Health Partners Plans partnering parties to overcome difficulties during claims processing. EDI Procedure notes should be taken into account before sending electronic claims to Health Partners Plans.

What information do I need to submit my claims electronically to Health Partners Plans?

The following items are required on claims sent electronically for Health Partners Plans members:

  • The Health Partners Payor ID Number: 80142

National Provider Identifier (NPI) Failure to include this information will result in rejection of the claim.

What is my NPI ID Number?

The National Provider Identifier is assigned to the provider by the Centers of Medicare and Medicaid Services (CMS). It is a valid 10-digit numeric value based on rules supplied by CMS.

What do I do if I do not have a computer to submit claims electronically?

If you do not have the appropriate equipment for electronic claims process, we suggest that you contact Emdeon\WebMD (the EDI clearinghouse used by Health Partners Plans), or your billing software vendor, for more information.

I do not currently submit claims electronically. How do I begin?

Contact your billing software vendor and request that your claims be submitted electronically via the WebMD claims clearinghouse. Your vendor will help you with the specifics of your setup.

What if my billing software vendor uses another clearinghouse such as NDC, Med-E America, ETS, Equifax, etc.?

Emdeon\WebMD is the leading EDI clearinghouse in the country and most claims clearinghouses forward claims to Emdeon\WebMD for processing. Please contact your billing software vendor for details.

Once I am set up to send claims electronically, how many claims should I initially send?

You can start by sending 20-30 claims to ensure no issues exist. You contact the Claims Department (EDI) Support Line after submitting the first batch of claims so that Health Partners Plans can analyze them for any potential issues.

Why can’t I just use email to submit my claims electronically?

Email is very different than EDI. The EDI data is transmitted in a structured format, based on the use of transaction standards, which ensures that all participants use a common language.

Are  reports created for providers that identify claim rejections/errors?

Yes, there are two types of reports available to providers.

  • RPT01/RPT05: This report identifies all claim rejections with invalid and/or missing data that have been sent back to the provider from WebMD. Claims rejected at this level cannot be identified by Health Partners and are rejected before reaching Health Partners Plans claims processing system. To inquire about claim error(s) found on this report, please contact your billing software vendor.
  • RPT10/RPT11: This report identifies all claim rejections with invalid and/or missing data that have been sent back to the provider from Health Partners Plans. To inquire about claims errors found on this report, please contact the Claims Deparatment (EDI) Support Line and provide the Carrier Reference Number (Car Ref #) of the error(s) in question to the representative.

The provider is responsible for updating all errors found on these reports and for retransmitting the corrected data to Health Partners Plans in a timely manner.

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