Provider Claim Guidelines

Provider Claim Guidelines For UHA Trading Partner

As of October 1, 2015, all HIPAA-covered entities are required to use ICD-10 codes for services on or after that date. UHA is committed to the timely and accurate processing of your claims, and encourage claim submission through electronic data interchange (EDI). There are three ways to submit medical claims electronically. You may connect either directly to UHA, submit your claims through a clearinghouse that has a connection with UHA, or through the Hawaii Xchange online service.

All methods are quick to set up and providers who submit claims electronically will enjoy:

  • Faster processing and reimbursement of claims
  • Proof of timely submission through electronic acceptance reports
    • Reduced number of lost claims
    • Reduced costs associated with labor, paper, and postage for claims

There are two ways to submit EDI claim submissions. A connection can be made directly to UHA as an 837 transaction or through the Hawaii Xchange online service. You must be able to generate a HIPAA 837 formatted claim transaction file to send directly to UHA.

Registration and Approval by UHA

UHA requires prior approval of any EMC and EDI submission arrangements from any source. There are two parts to the approval process. Part One concerns the technical details of the data processing arrangement to be used. Part Two relates to the specific provider whose transactions are submitted via electronic data interchange. UHA must review and approve each provider’s request to participate, and each provider is required to sign an Electronic Trading Partner Agreement. UHA reserves the right to revoke approval for a provider, group of providers, or organization participating in electronic data interchange with UHA. On-Site Inspection In order to ensure that the established UHA requirements are being met, providers must agree to allow periodic audits by UHA and its authorized representatives after implementation of this arrangement to verify that the necessary records are being retained in accordance with the Electronic Trading Partner Agreement.

To learn more about HIPPA EDI and become a certified EDI Professional please visit our course schedule page.

Leave a Reply

Your email address will not be published.

Post Navigation