Electronic Data Interchange (EDI)

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 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 customerservice@uhin.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 uuhpedi@hsc.utah.edu 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 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

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 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.
  • uTRANSEND - Clearinghouse services
  • Other clearinghouses - Several billing systems have created a connection to UHIN payers through a clearinghouse. There clearinghouses, 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
  • Navicur =
    • Payer ID # 4779 (professional claims )
    • Payer ID # 5920 (institutional claims)
  • Apex EDI = Payer ID # UHUOU
  • 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

Business Days

Monday – Friday, 7 am–4 pm

2016 Holiday Schedule

Holiday Date
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

Holiday Date
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

Paper Claims

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.

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.

  • EDI Form for 835, 837 (Trading Partner Setup) & EFT Enrollment (Electronic Funds Transfer)