UHA Claim Submission Requirements For Trading Partners
UHA Claim Submission must be processed using the codes required in the National Implementation Guides and the HIPAA rules. Each transmission to UHA should have a unique Interchange Control Number (ISA13). UHA will use this number to determine if it is a duplicate file. b. Submitters are required to submit a unique submission number for each transmission in a day. This number is located in BHT03, the Originator Application Transaction ID. This will be used as a duplicate check for each transaction.
- UHA will only accept one ISA-IEA per input file from a submitter. There can be multiple GSGE within one ISA-IEA. There can be multiple ST-SE in a GS-GE. There can be multiple claims in each ST-SE, up to the HIPAA specified maximum limit of 5,000 claims per ST-SE.
- UHA will edit down to the Claim Service Line level (Loop 2400). If there is a claim that does not conform to the X12 rules the entire ST-SE transaction set will be rejected.
- UHA will accept only one type of GS08 value (or only one type of transaction set) in any EDI physical file that is sent to UHA.
- For all character fields do not use: Asterisk (*), Equal sign (=), Pound sign (#), Apostrophe (’), Quote (“), Caret symbol (^)
- Service Line: Numbers in Loop 2400 LX segment should begin with one and be incremented by one.
- Negative Values may result in incorrect claim payment or processing.
- Formats are subject to changes and UHA will give 30 days notice before any format changes are made.
- ISA/IEA – Interchange Control Segment:
- ISA05 = “ZZ” (Mutually Defined)
- ISA06 = UHA Assigned Transmitter ID
- ISA07 = “30” (UHA’s Private Business Federal Tax ID)
- ISA08 = 990263440
- GS/GE – Functional Group Segment:
- GS02 = UHA Assigned Submitter ID
- GS03 = 990263440
- 1000A – Submitter Name: NM109 = UHA Assigned Submitter ID
- 1000B – Receiver Name:
- NM103 = “UNIVERSITY HEALTH ALLIANCE”
- NM109 = 990263440
- 2010AA – Billing Provider Name:
- NM108 = “24”
- NM109 = Billing/Pay-To Federal Tax ID
- 2010BA – Subscriber Name:
- NM108 = “MI” (Member Identification Number)
- NM109 = UHA Assigned Member ID # on Subscriber’s ID Card
- 2010CA – Patient Name:
- NM108 = “MI” (Member Identification Number
- NM109 = UHA Assigned Member ID # on Patient’s ID Card
- 2310 – Provider Secondary Information:
- REF01 = “1G” (Provider UPIN)
- REF02 = UHA assigned Provider PIN.
To learn more about HIPAA EDI and become a certified EDI Professional please visit our course schedule page.