Ohana Health Plan EDI

Ohana Health Plan EDI Claims Submission Guidelines

Ohana Health Plan EDI Claims are sent electronically via EDI. Ohana Health Plan EDI Claims Submission is less costly than billing with paper and, in most instances, the Plan can process your electronic claim in half the time of a paper claim. For EDI submissions, providers should follow the HIPAA transaction and code set requirements as found in the National Electronic Data Interchange Transaction Set Implementation Guides, which are available at www.wpc-edi.com. Ohana Health Plan EDI Claims submitted to the Plan must be in the ANSI ASC X12N format, version 4010A.

Clearinghouses for Electronic Claims

Ohana receives electronic claims from seven clearinghouses. Clearinghouses charge varying fees. Providers may wish to contact their clearinghouse or billing software vendor to see if they offer free options.

Encounter Data

For claims encounter submissions, please use ‘Ohana Payer ID number 59354 for all clearinghouses.

EDI Questions & Assistance

For inquiries related to your electronic claim submission to ‘Ohana, please contact Ohana Health Plan EDI team, who will help identify, test and correct any issues.

Free EDI Options

Ohana does offer the following free EDI options:

  1. You can visit the ACS EDI Gateway Web site (www.acs-gcro.com) to download free WINASAP2003 software for electronic billing as well as enrollment forms.
    • When the software is completely downloaded, there will be an icon on your desktop.
    • Providers will need to double click on the icon to open the program.
    • The password is ASAP.
    • Once the program is open, go to file> open payer> and select ‘Ohana. (The correct Payer ID number, 77004, is programmed.).
    • Providers will also need to complete the application form and fax it to 1-850-385-1705. After five days, you will receive a welcome letter. You may call 1-800-987-6720 to request the information be sent via fax.
  2. You can submit claims at the DDE (Direct Data Entry) portal on www.ohanahealthplan.com. If you haven’t registered on our Web site, please do so. You will have immediate access to eligibility, claims status and so much more.
  3. Availity offers a free Web-based DDE product (institutional and professional) to ‘Ohana providers. Providers can register with Availity and view a demonstration of this product by visiting www.availity.com. Simply click on “Products and Services” to verify all connection requirements.
  4. Legacy Consulting also offers a free product to ‘Ohana providers. Providers can register by visiting www.administep.com. Simply click on “Sign Up” to get started.

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