EDI Tips for Affinity Health Plan Claims Submission

EDI TipsEDI Tips listed in today’s blog post will be helpful information to all parties involved in the process of 837 EDI Claims exchange with Affinity Health Plan. In the previous post we have already given you some Affinity Health Plan Claims guidelines and today we add a portion of EDI Tips. EDI Tips are given in the form of frequently asked questions.

What is Affinity’s Payer ID Number?

Affinity utilizes these Payer ID Numbers:

  • 13333
  • 13334
  • 23334
  • 43324

When do I use Payer ID 13333? For all Medicare Advantage and Medicaid Advantage claims.

When do I use Payer ID 13334? For all Medicaid, Child Health Plus, and Essential Plan claims.

When do I use Payer ID 23334? For all Qualified Health Plan (HIX) claims.

When do I use Payer ID 43324? For all Behavioral Health claims. You will also need to include Affinity’s plan ID of 009.

What are the key benefits to EDI Submission?

There are several direct and recognizable benefits to submitting claims electronically:

  • Greater claim accuracy due to electronic edits.
  • Confirmation and rejection reports to track claim routing.
  • Reduction in accounts receivable due to more timely claims processing for submitters and receivers.
  • Reduction in the cost and time associated with hard copy printing and mail preparation.
  • HIPAA compliance.
  • EDI filing support services offered by the clearinghouse and Affinity staff.

Which clearinghouse does Affinity Health Plan use? Emdeon

Does Affinity Health Plan accept claims directly via website?

Currently, Affinity does not offer direct data entry for claims and only accepts claims filed electronically via its partner clearinghouse, Emdeon.

What if I am not currently sending claims to Emdeon?

If you are already sending claims through Emdeon for other payers, you do not need to contact them, just begin submitting Affinity claims electronically, following the guidelines identified in EDI Information. If you are NOT currently submitting claims through Emdeon for other payers, you or your billing vendor will need to establish a connection for electronic submission with them. You can contact Emdeon for instructions and guidelines.

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