Electronic data interchange (EDI) requirements and setup
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 requires that all health care providers and payers must use the X12 5010 version to exchange EDI business data.
Electronic data interchange (EDI) setup
We accept EDI files through a direct connection via Secure File Transfer Protocol (SFTP) and through clearinghouses.
Priority Health doesn't publish companion guides, as we strictly adhere to HIPAA standards. Refer to Products I X12.
Submit the following forms to the Priority Health EDI team at firstname.lastname@example.org.
To receive the 835 payment/remittance advice electronically:
Service receipts summarize the number of claims submitted to Priority Health, including upfront rejections.
- They are sent directly to your office by email or fax as selected by your office.
- The report lists any claims rejected up front for invalid or missing data elements.
Transaction types available for EDI
- 270, Eligibility requests, batch and real time
- 271, Eligibility responses, batch and real time
- 276, Claim status requests, batch and real time
- 277, Claim status responses, batch and real time
- 277CA, Claim acknowledgment
- 278, Authorizations
- 834, Group enrollment
- 835, Payment/Remittance advice
- 837P, 837I and 837D, Claims
- 999, Functional acknowledgements
Real-time transaction exceptions
Eligibility and claim status transactions are both available 24/7, with these exceptions:
- Regularly scheduled maintenance periods, which occur on the second weekend of each month.
- Non-routine downtime periods, which are published a week in advance.
- Unscheduled downtime periods, which are communicated within an hour directly to clearinghouses and/or trading partners who utilize real time services.
Direct questions about electronic data interchange setup to our EDI team via email at email@example.com.
If you have additional questions about member status, provider portal, Filemart or payments, reference our Get your questions answered document to see how to get your inquiry to the right Priority Health team.
- Electronic data interchange (EDI)
- PH reporting packages
- Access APCD extracts
- HL7 patient health information
Contact your software vendor or data clearinghouse for payer IDs not listed below.
Payer ID = 38217