Electronic Data Interchange (EDI)
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
Of the claims that University of Utah Health Plans (U of U Health Plans) receives electronically, 80% pass through our claims processing system without processor intervention. The average turnaround time for EDI claims (received
UUHP is currently accepting the following HIPAA-compliant transactions:
- 837 005010X222A1 (Professional claims)
- 837 005010X223A2 (Institutional claims)
- 277CA Claim Acknowledgement/
- 999 Acknowledgement
- 835 005010X221A1 (Remittance
- EFT (Electronic funds transfer) in conjunction with the 835
- COB (Coordination of Benefits)
- 270/271 0051010X279A1 Eligibility Request/Response (real time)
- 276/277 Claim
statusinquiry/response (real time)
If EDI Connection issues occur during off hours for real time 270/271 and 276/277 transactions please contact U of U Help Desk at 801-587-6000.
In compliance with CORE
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 standardizations of electronic interactions.
For more information about UHIN.
UUHP’s trading partner number with UHIN is HT000179-002 for production files and HT000179-003 for test files.
Getting Started With EDI Enrollment
All HIPAA-compliant transactions with University of Utah Health Plans must be submitted through the Utah Health Information Network (UHIN). For more information about UHIN and its services, visit www.uhin.org.
Trading Partner Registration
Before University of Utah Health Plans can process transactions, the submitting trading partner must obtain a trading partner ID and complete enrollment for services through UHIN. Contact by email at email@example.com or by calling 801-466-7705.
Step 1: Contact UHIN and receive a copy of the UHIN Electronic Commerce Agreement (ECA)
Please be aware that the ECA is a legal document and it refers to clearinghouse services as “Administrative Messages.” If you want to enroll for clearinghouse services, please check the option for Administrative Messages on page 1 of the ECA.
Step 2: Complete the UHIN Enrollment form
Make sure that you select all transaction types you will be exchanging (837, 835, 270, etc.).
UHIN will forward the enrollment information directly to University of Utah Health Plans to complete your set-up to submit EDI transactions electronically.
If you or your provider practice is new to EDI, you must register with UHIN and UHIN will then forward the information to University of Utah Health Plans. If you’re already registered with UHIN but not with University of Utah Health Plans and you only need to register your Trading Partner with University of Utah Health Plans, please complete the 837 Trading Partner Setup- Electronic Form or 837 Trading Partner Setup-Printable Form and return it to University of Utah Health Plans by email to firstname.lastname@example.org or fax to (801) 281-6121.
EDI Enrollment Process for the 835 and EFT
All HIPAA-compliant transactions with University of Utah Health Plans route through the Utah Health Information Network (UHIN). A Provider must obtain an UHIN Trading Partner number to receive EDI Transactions from the University of Utah Health Plans. A Provider must be enrolled with the 837 to receive the 835 and EFT transaction. The 835 and EFT transactions are linked together by the Billing Provider NPI and a Provider must enroll in both transactions. To receive the 835 a provider must be enrolled with the EFT, and to receive the EFT a provider must be enrolled with the 835.
Provider must complete the University of Utah Health Plans 835 and Electronic Funds Transfer (EFT) Authorization Agreement Form. This form can be submitted either electronically or by paper.
- Electronic form
- Paper form
- Paper form can either be sent to University of Utah Health Plans by fax 801-281-6121 or by email email@example.com
Once the UUHP has received the EDI Enrollment form, UUHP will begin setting up the EDI connections. The provider will be notified by email once the setup is complete.
**If providers want transaction information from the bank. It is the provider’s responsibility to set this up with their financial institution. View a copy of a sample letter to send to your financial institution to request this: Sample Provider EFT Re-Association Letter.
Any EDI enrollment questions can be sent to firstname.lastname@example.org
U of U Health Plans currently administers the following plans:
- Healthy Premier- Group
- Healthy Preferred- Group
- Medicaid Products
- Healthy U Traditional Medicaid
- Healthy U Non-Traditional Medicaid
- HOME (Healthy Outcomes Medical Excellence)
- Healthy Advantage Plus HMO
- Healthy Advantage (HMO) Medicare Plan
- University of Utah Employee Health (University Health Care Plus)
- University of Utah Health Plans Marketplace
- Healthy Premier Individual & Family Plans
- UNI-BHN Carve-Outs (mental health claims only)
Submitting Claims Through UHIN
There are several different options for submitting claims through UHIN. These include the following:
- Direct link - Provider is creating
a HIPAAcompliant 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-basedproduct, UHINTis free to UHIN members.
- uTRANSEND - Clearinghouse services
- Other clearinghouses - Several billing systems have created a connection to UHIN
payersthrough a clearinghouse. Thereclearinghouses, in turn, connect to UHINet.
UHIN Contracted Clearinghouses
A partial list of UHIN contracted clearinghouses appears below:
- Relay Health/McKesson =
- Payer ID #4779 (professional claims)
- Payer ID # 5920 (institutional claims)
- WebMD/Emdeon = payer ID # SX155
- Capario = Payer ID # SX155
- Gateway EDI= Payer ID # 00179
- Payer ID # 4779 (professional claims )
- Payer ID # 5920 (institutional claims)
- Apex EDI = Payer ID #
- Ingenix = Payer ID # SX155
- SSI Group: SX155
- Zirmed: Z1030
- Practice Insight: SX155
- Med USA: HT000179-002
- Office Ally: SX155
- ENS Clearinghouse: SX155
*Please note - Payer ID numbers are assigned by the clearinghouse. As University of Utah Health Plans does not assign or maintain these numbers, please contact your clearinghouse for this information.
Hours & Schedule
Monday – Friday, 7 am–4 pm
2016 Holiday Schedule
|New Year's Day||Friday, January 1|
|Martin Luther King Jr. Day||Monday, January 18|
|Presidents’ Day||Monday, February 15|
|Memorial Day||Monday, May 30|
|Independence Day||Monday, July 4|
|Pioneer Day (Observed)||Monday, July 25|
|Labor Day||Monday, September 5|
|Thanksgiving Day||Thursday, November 24|
|Day after Thanksgiving||Friday, November 25|
|Christmas Day (Observed)||Monday, December 26|
2017 Holiday Schedule
|New Year’s Day (Observed)||Monday, January 2|
|Martin Luther King, Jr. Day||Monday, January 16|
|Presidents’ Day||Monday, February 20|
|Memorial Day||Monday, May 29|
|Independence Day||Tuesday, July 4|
|Pioneer Day||Monday, July 24|
|Labor Day||Monday, September 4|
|Thanksgiving||Thursday, November 23|
|Day After Thanksgiving||Friday, November 24|
|Christmas Day||Monday, December 25|
There may be instances when you need to submit your claims on paper. U of U Health Plans has no plans at this time to require providers to submit claims electronically. However, UUHP would prefer that providers submit claims electronically, so if you need assistance on how to send EDI claims please contact us.
Phone: (801) 587-2638 or (801) 587-2639
Fax: (801) 587-6433
Tips for Submitting Claims
The 5010 837 transaction allows for providers to submit a claim electronically while submitting attachments on paper. Elements in the file will indicate if you are sending an attachment, the type of attachment you are sending, and identification number for the attachment and the mode for sending the attachment (fax, email, etc.)
U of U Health Plans feels this is a valuable tool and would ask that providers who submit an electronic claim and also submit a paper attachment for that claim to use these fields. When sending UUHP an attachment, please verify that the identification number that was provided in the electronic file is also on the attachment so we can identify the claim that the attachment belongs to. We will
U of U Health Plans can accept corrected claims by EDI and U of U Health Plans prefers to receive claims by EDI. There are two ways a provider may submit a corrected claim.
- Claim Header Level: Place a code 7 in the CLM05-3 segment (see 5010 Implementation Guides on Claim Frequency Type Code, page 161)
- Service Line Level: Place a CC modifier on the service line.
Only one method is required to submit a corrected claim, UUHP does not need to have both codes sent on a claim.
Claim notes, claim line notes (professional claims only) and claim billing notes (institutional claims only) can be submitted in the electronic file. UUHP will not know if the claim note(s) affect the claim payment, therefore UUHP will
- Accident details
- Auto or subrogation detail
- Any special circumstances
You can find more information about claim and claim line notes on page 211 and page 415 of the Professional Implementation Guide. You can find more information about claim notes and claim