HIPAA Electronic Data Interchange (EDI)

Health Insurance Portability and Accountability Act (HIPAA) Electronic Data Interchange (EDI) is an electronic method of communicating standard transactions between covered entities (providers, clearinghouses, and health plans). HIPAA EDI allows covered entities to submit and retrieve the HIPAA-mandated transactions from Washington State Medicaid.

Begin submitting your claims electronically.

ProviderOne Trading Partner Agreement (TPA)

As a covered entity wishing to submit electronically, you must:

  • Complete the ProviderOne enrollment process and obtain a ProviderOne identification number before completing the TPA.
  • Include your ProviderOne ID on the TPA before sending it in to the Health Care Authority.

See a list of approved clearinghouses, billing agents, and software vendors.

EDI testing required

You are required to successfully complete EDI testing for each HIPAA transaction you plan to use. Refer to the companion guides below for additional information.

ProviderOne 5010 companion guides

Implementation guide and codes

The following materials are available from Products | X12 to assist you in your submissions:

  • Implementation guides (TR3)
  • Provider taxonomy codes
  • Claim adjustment reason codes (CARC)
  • Remittance advice remark codes (RARC)
  • Claim status codes

For assistance

If you have questions related to your HIPAA EDI files or responses, please submit a ticket at hipaa-help@hca.wa.gov. Help us resolve your concerns more quickly by providing the following details:

  • Name
  • Phone number
  • Email address
  • Your seven-digit domain/ProviderOne identification number
  • National Provider Identifier (NPI)
  • Transaction that you are working on
  • File name
  • A detailed description of the concern