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.
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Electronic submitters must complete the ProviderOne enrollment process and obtain a ProviderOne identification number before completing the ProviderOne Trading Partner Agreement. Electronic submitters must include their ProviderOne ID on the ProviderOne Trading Partner Agreement before sending it in to the Health Care Authority.
See a list of approved clearinghouses, billing agents and software vendors.
Covered entities (clearinghouses, providers, health plans) are required to successfully complete EDI testing for each HIPAA transaction they plan to use. Refer to the companion guides below for additional information.
- 270/271 Eligibility inquiry and response
- 276/277 Claim status request and response
- 835 Payment/advice
- 837 Professional
- 837 Institutional
- 837 Dental
- 837 Encounters
- 834 Benefit enrollment and maintenance
- Payer Initiated Eligibility (PIE) Transaction
The following materials are available from Washington Publishing Company 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
If you have questions related to your HIPAA EDI files or responses, please submit a ticket at firstname.lastname@example.org. Help us resolve your concerns more quickly by providing the following details:
- 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