Oxford Health Plans EDI

Oxford Health Plans EDI Mission General Directives

Oxford Health Plans EDI program is an advanced form of electronic business-to-business communication that instantly links your computer system with Oxford Health Plans, other health plans, and government payers. Patient information is transferred between health care professionals and payers in a standardized, secure, and efficient manner.

With Oxford Health Plans EDI you can perform the following transactions in batch or real time:

  • Check patient eligibility and benefits
  • Submit or check referrals, authorizations and notifications
    Submit or check claims
  • Receive direct deposit of claim payments and electronic Explanation of Benefits (EOBs)
  • Improve cash flow
  • Confirm patient eligibility to ensure that you bill the right payer, the first time
  • Receive immediate feedback on your claims, allowing you to correct errors at the time of initial submission
  • Eliminate mail and handling time for your claims, which may improve your cash flow. ERA/EFT saves trips to the bank by depositing payments directly into your accounts
  • Reduce administrative expenses
  • Buy less ink, paper and stamps
  • No cost and low cost clearinghouses are available
  • Reduce paperwork
  • Submit the majority of your claims electronically
  • Enter your precert and notifications electronically and eliminate the precertification-by-fax form.

With ERA/EFT, you no longer have Explanation of Benefits (EOB) to file or checks to deposit; the EOB/remittance information is provided online (and can be printed if desired) and payment is deposited to your bank accounts.

  • Reduce phone calls
  • Check eligibility and benefits at your convenience
  • Check referrals, notifications and precertification requests without hold time
  • Check the status of multiple claims quickly.

Following Oxford Health Plans EDI program will help you submit all or most of your claims electronically, without paper forms or attachments. Insurance carriers prefer to receive your claims electronically and will request additional information when needed. Electronic claims are received faster, have fewer errors and benefit the health care system with administrative savings.

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