Passport Health Plan EDI

Passport Health Plan EDI Requirements for Medical and Hospital Claims

Passport Health Plan EDI Program encourages all providers to submit claims electronically. Passport Health Plan EDI Program allows faster, more efficient, and cost-effective claim submission for providers. EDI, performed in accordance with nationally recognized standards, supports the health care industry’s efforts to reduce administrative costs. The benefits of Passport Health Plan EDI billing electronically include:

  • Reduction of overhead and administrative costs. EDI eliminates the need for paper claim submission. It has also been proven to reduce claim rework (adjustments).
  • Receipt of reports as proof of claim receipt. This makes it easier to track the status of claims.
  • Faster transaction time for claims submitted electronically. An EDI claim averages about 24 to 48 hours from the time it is sent to the time it is received. This enables providers to easily track their claims.
  • Validation of data elements on the claim form. By the time a claim is successfully received electronically, information needed for processing is present. This reduces the chance of data entry errors that may occur with the use of paper claim forms.
  • Quicker claim completion. Claims that do not need additional investigation are generally processed quicker. Reports have shown that a large percentage of EDI claims are processed within 10 to 15 days of their receipt.

All the requirements for paper claim filing apply to electronic claim filing.

Hardware/Software Requirements

There are many different products that can be used to bill electronically. As long as you have the capability to send EDI claims to Emdeon, whether through direct submission or through another clearinghouse/vendor, you can submit claims electronically. Emdeon is the largest clearinghouse for EDI health care transactions in the world. It has the capability to accept electronic data from numerous providers in several standardized EDI formats and then forward accepted information to carriers in an agreed upon format.

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