EDI (Electronic Data Interchange)
Introduction
Electronic data interchange (EDI) offers significant benefits for both providers and payers. Electronic claims can help improve efficiency, productivity and cash flow for providers, while payers can see benefits in the reduction of data entry errors and faster turn around times.
Of the claims that University of Utah Health Plans (UUHP) receives electronically, 80% pass through our claims processing system without processor intervention. The average turn around time for EDI claims (received date to check being received in the provider's office) is 8 days.
UUHP is currently accepting the following HIPAA-compliant transactions:
- 837 004010X098A1 (professional claims)
- 837 004010X096A1 (institutional claims)
- 277FE in response to incoming 837 claims files
- 997 in response to incoming 837 files
- 835 004010X091A1 (remittance advice)
- EFT (electronic funds transfer) in conjunction with the 835
As UUHP begins to test and implement the other transactions we will notify the EDI contact at your organization.
UUHP currently administers the following plans:
- Medicaid Products
- Healthy U Traditional Medicaid
- Healthy U Non-Traditional Medicaid
- Habilitative Options & Medical Excellence (HOME)
- Flex Care
- University of Utah Employee Health Plan
- EAP Carve Outs (mental health claims only)
- Questar
- Mark Steel
- Tesco
- CHIP A
- CHIP B
- CHIP C
- Utah Sheet Metals
- Equitable
- Morgan School District
- Vista Staffing Inc
- U of U Behavioral Health
- Mt West Telecom
- Disabled Miners' Health Trust
Utah Health Information Network
UUHP is a member of the Utah Health Information Network (UHIN), a non-profit coalition of payers and providers in Utah. UHIN members have come together to reduce the administrative costs of health care through standardization of electronic transactions.
For more information about UHIN see www.uhin.com.
UUHP's trading partner number with UHIN is HT000179-003 for test files and HT000179-002 for production files.
Submitting claims through UHIN
There are several different options for submitting claims through UHIN. They include:
- Direct Link - provider is creating a HIPAA compliant file from their billing system and is sending the file to the UHIN HIPAA server (UHINet).
- ProClaim - a Regence dial-up product. ProClaim is free to UHIN members.
- UHINT - an internet-based product. UHINT is free to UHIN members.
- Other Clearinghouses - several billing systems have created a connection to UHIN payers through a clearinghouse. These clearinghouses, in turn, connect to UHINet. A partial list of UHIN contracted clearinghouses appears below:
- Apex EDI
- Cortex EDI
- CPSI
- Global HealthNet
- HBOC
- HBOC Institutional
- PER-SE Transaction Services Inc
- Proxymed
- Utah Local Governments Trust
- WEBMD Corp
- Zirmed.com Inc
Please email us if the clearinghouse you are using is not in the above list.