Electronic Data Interchange (EDI) For Providers WellFirst Health
WellFirst Health offers HIPAA-compliant electronic transactions to providers to meet consistent documentation, handling and privacy standards as well as for efficiency.
Eligibility and Benefit Inquiry and Response (270/271)
The most timely and accurate way to confirm a member’s benefits and coverage amounts is to submit an eligibility request transaction. WellFirst Health supports this transaction in either real-time or batch. To engage in EDI transmission, the partner should complete an EDI setup form or if it utilizes a clearinghouse or billing service, has to reach out to WellFirst Health to arrange transmission.
Health Care Claim Submission (837)
Electronic claim submission allows for standardized transmission of claims data, resulting in fewer rejections and more streamlined claims adjudication. WellFirst Health accepts the 837 Health Care Claim: Professional (837P) and Institutional (837I) transactions. To submit claims electronically, the partner should complete an EDI setup form or if it utilizes a clearinghouse or billing service, has to reach out to WellFirst Health to arrange transmission.
Claim Acknowledgment (277CA)
Electronic claim acknowledgment files are a response to the electronic claim submission (837) files WellFirst Health receives. Each claim is identified individually as to whether or not it was accepted for processing or was rejected. Reasons for rejections are also supplied in the response.
Health Care Claim Status Request and Response (276/277)
Electronic claim status requests allow inquiry and response to quickly know the status of a claim that had been accepted for adjudication. WellFirst Health supports this transaction in either real-time or batch. The provider should wait a minimum of 30 days after claim submission to send a claim status request to allow for the known payment processing time.
To learn more about EDI and become a certified EDI Professional, please visit our course schedule page.