Electronic Data Interchange (EDI) - Providers

Electronic Data Interchange (EDI)

Subscribe to our EDI mailing list and receive up-to-date information and announcements.

Alternative Options: If you are not happy with your current practice management system (PMS) vendor, take a look at some of your options for HIPAA compliance.
ANSI ASC X12N 4010 Specifications: These documents are in portable document format (PDF) and may be downloaded from this Web site.
X12N User Guide (PDF)
Compliance Statement: This statement advises providers of the efforts to address the administrative simplification provisions of HIPAA.
Contact EDI Services: This section contains contact information.
Electronic Claims Testing: This information will help lead you through the process you must follow to become approved for electronic claims submission in the new HIPAA-compliant format.

Electronic Data Interchange:
Private Business Transaction Companion Document (PDF) This document provides additional guidance concerning the segments/data elements necessary to successfully process HIPAA-compliant ANSI X12N version 5010 270/271, 276/277 and 278 transactions for private business members.

WPC-EDI.com This link will take you to the WPC electronic data interchange health care transactions site. This site will contain the ANSI X12 implementation guidelines that can be downloaded.
EDI Forms: All forms must be signed and returned to EDI Services via mail or fax. These forms are in portable document format (PDF) and allow you to complete them online, print, sign and mail or fax to the appropriate address/fax number.
Electronic Remittance Advice (ERA) (PDF)
Submitter Information Update Form (PDF)
Trading Partner Agreement (TPA) (PDF)
Trading Partner Agreement Definitions (PDF)

HIPAA Compliant Vendors List (PDF): A directory of electronic-billing vendors who have successfully tested with us and are in production for the Health Insurance Portability Accountability Act (HIPAA) version of the X12N 837 Health Care Claim.

Secondary Coverage Information:
Health Advantage Billing Requirements for ANSI 837I Secondary Coverage (PDF)

Health Advantage Billing Requirements for ANSI 837P Secondary Coverage (PDF)

Institutional COB Billing Requirements (PDF)

ITS Institutional Secondary Payer Requirements. (PDF)

ITS Professional Secondary Payer Requirements (PDF)

Professional COB Billing Requirements (PDF)