EDI setup for claims, RAs & more

We can help you set up your office to exchange electronic transactions with us through Electronic Data Interchange (EDI).

• We exchange electronic enrollment data with employer groups using the 834 enrollment transaction.
• Claim acknowledgment receipts are sent directly to the provider office, usually the same day but no later than the next business day.
• Claim acknowledgments contain any up-front edit rejections which, if correctable, will require resubmission.
• Acknowledgments are delivered by e-mail or by fax, as selected by your office. See the Service Receipt sample below.
• The 277U Claim Acknowledgment transaction is also available electronically.

Available transactions

270 Eligibility requests
271 Eligibility request responses
276 Claim status requests
277 Claim status request responses
278 Referrals and authorizations
835 Payments, remittance advice
837 Claims

EDI formats/methods accepted

We accept files in ANSI X12 4010A1 (HIPAA-compliant) file format. There are several transmission methods available:

• BBS (bulletin board service)
  You can use our dial-up BBS (Bulletin Board Service) to send us information directly, no encryption needed. Contact your software vendor to find out if your system is capable of sending us files directly in this format.
  
• FTP or SFTP (file transfer protocols)
  Use FTP or SFTP to send and receive encrypted files over the internet (PGP encryption required). Contact your software vendor to find out if your system is capable of sending us files directly in this format.
  
• Clearinghouses
  While a direct connection is preferable, you can go through a clearinghouse with which you have a Trading Partner Agreement (see list on the left).
  

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Setting up your EDI connection

To submit HIPAA-compliant electronic (EDI) claim files, follow the steps below.

1. Register.
Create an electronic account with us by completing an (837) Electronic Claim Registration form or (835) Electronic Remittance Advice Registration form and faxing it to the Priority Health EDI Team at 616 942-9932.

• Print the Electronic Claim Registration Form (47KB PDF)
• Print the Electronic Remittance Advice Registration Form (50KB PDF)
  

2. Complete a Service Receipt form.
This form allows Priority Health to notify you directly that we have received your claims. It's very important to ensure that you are set up to receive this receipt so you can get the upfront edits and rejections as soon as possible.

• Service receipt form (33KB PDF)
• See an example of the Service Receipt (16KB PDF)

Questions?

E-mail the Priority Health EDI team at EDISETUP@priorityhealth.com, or call them at 800 942-0954, ext. 48686.


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