Submitting an Electronic Claim

The Health Plan currently accepts claims in the HIPAA 837 format.

We do not have a payor number. A payor number is a number utilized by clearinghouse to designate a Payor. We accept claims direct at no cost and assign a User ID and password at the time of testing. We currently do not pay to receive claims. There are several clearinghouses that charge the Payor for the receipt of claims.

We accept claims from several clearinghouse successfully for years. We do not recommend any particular clearinghouse but we can provide some of the companies we have been receiving claims from.

We have two (2) methods of transmitting the HIPAA 837 format: Internet or FTP.

Follow these steps:

• Prepare a TEST file of claims; over 10 claims
• Once you have a TEST file, contact EDI Support for sign on/password set up
• Send TEST file
• File will be evaluated and response within two (2) business weeks

Upon successful TEST file, you can begin immediately to send your claims. A HIPAA 997 notice will be sent to you on the day of receipt and we also provide a detail report of each claim as a courtesy within 24-48 hours. These reports are sent to the submitter of the claims not the provider unless they are one in the same.
 

A Trading Partner Agreement must be completed by you or your clearinghouse prior to submitting a TEST file. Located on this website are also Internet File Transfer Instructions , if you choose to use the Internet method.

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