Electronic Data Interchange (EDI)

• Introduction
• Enrollment
• Plans
• Submitting Claims
• Forms

• Introduction

  Why 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 payers can see benefits in reduction of data entry errors and faster turnaround times.

  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 date to check being received in the provider office) is 15 days.

  Accepted Transactions

  UUHP is currently accepting the following HIPAA-compliant transactions:

  • 837 005010X222A1 (Professional claims)
  • 837 005010X223A2 (Institutional claims)
  • 277CA Claim Acknowledgement/error report
  • 999 Acknowledgement
  • 835 005010X221A1 (Remittance advice)
  • EFT (Electronic funds transfer) in conjunction with the 835
  • COB (Coordination of Benefits)
  • 270/271 0051010X279A1 Eligibility Request/Response (real time)
  • 276/277 Claim status inquiry/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 requirement 270 U of U Health Plans uses the UHIN clearinghouse for all EDI transactions. Please view the UHIN Connectivity Companion Guide for further instructions. Connectivity Companion Guide can be located at www.uhin.org.

  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.

• Enrollment

  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). 

  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. Go to https://uhin.org/join/ to start the enrollment process.

  Step 1: Fill out UHIN’s Electronic Commerce Agreement (ECA)

  Step 2:  Fill out the Notice of Delegation

  Step 3:  Complete the UHIN Enrollment Form

  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’re already registered with UHIN, but not with University of Utah Health Plans, complete the UHIN Clearinghouse Services Change Form.

  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 uuhpedi@hsc.utah.edu

  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.

  Questions?

  Any EDI enrollment questions can be sent to uuhpedi@hsc.utah.edu

• Plans

  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)
  • MHC
• Submitting Claims

  Submitting Claims Through UHIN

  There are several different options for submitting claims through UHIN. These include the following:

  • Direct Connection - Including Web Services and SFTP.
  • UHIN Free Software - Includes UHINt and the MYUHIN suite of products (File Tool, Eligibility Tool, and more)/li>
  • uTRANSEND - Web portal for retrieving acknowledgment reports and remittance advice
  • Other clearinghouses - UHIN has a connection to most national clearinghouses and supports all HIPAA-compliant billing software.

  UHIN Contracted Clearinghouses

  A partial list of UHIN contracted clearinghouses appears below:

  • Relay Health/McKesson: Payer ID # UNUTHP
  • Change Healthcare/Emdeon:  Payer ID # SX155
  • Gateway EDI: Payer ID # 00179
  • Navicure: Payer ID # SX155
  • Apex EDI: Payer ID # UHUOU
  • SSI Group: Payer ID # SX155
  • Zirmed: Payer ID # Z1030
  • Practice Insight: Payer ID # SX155
  • Med USA: Payer ID # HT000179-002
  • Office Ally: Payer ID # SX155
  • ENS Clearinghouse: Payer ID # 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

  Claims can be submitted 24/7.

  UHIN Customer Service Hour

  M-F 7:00 a.m. - 6:00 p.m. with 24/7 emergency support

   

  EDI Support

  Phone: (801) 587-2638 or (801) 587-2639
  Fax: (801) 587-6433
  Email: uuhpedi@hsc.utah.edu

  Tips for Submitting Claims

  Attachments

  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 pend all claims that you have indicated have an attachment until we have received that attachment.

  Corrected Claims

  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.

  1. Claim Header Level: Place a code 7 in the CLM05-3 segment (see 5010 Implementation Guides on Claim Frequency Type Code, page 161)
  2. 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.

  Notes

  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 pend any claims with claim notes for review. If the notes you are submitting do not affect claim payment the claims will take longer to process as they will require manual review, so we ask that you limit claim notes to only information such as:

  • 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 billing notes on pages 180 and 182 of the Institutional Implementation Guide.

• Forms
  • EDI Form for 835, 837 (Trading Partner Setup) & EFT Enrollment (Electronic Funds Transfer)
    • Electronic Form: UUHP EDI Enrollment
    • Printable Form: PDF Form