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EDI Claims Submissions

Benefits of Using EDI for Claim Submissions
Electronic Submission of Claims Types
EDI training partners

Electronic Data Interchange (EDI) is an electronic exchange of information, in a standardized format that adheres to all Health Insurance Portability and Accountability Act (HIPAA) requirements. It is the transfers of structured data, by agreed message standards, from one computer system to another without human intervention.

Benefits of Using EDI for Claim Submissions

Benefits of Electronic Data Interchange (EDI) transmission include:

  • Reduced Overhead Expenses – Administrative overhead expenses are reduced, because the need for handling paper claims is eliminated.
  • Improved Data Accuracy – Because the claims data submitted by the provider is loaded directly into Kaiser Permanente’s computer by the clearinghouse, data accuracy is improved, as there is no need for re-keying or re-entry of data.
  • Additionally, “up-front” edits applied to the claims data while information is being entered at the provider’s office, and additional payer-specific edits applied to the data by the clearinghouse before the data is transmitted to the appropriate payer for processing, increase the percentage of clean claim submissions.
  • Reduced Turnaround Time – EDI claims bypass manual processes and paper handling at Kaiser Permanente;. Ttherefore, the turnaround time for processing EDI claims is substantially reduced (as compared to processing paper claims).
  • Bypass U.S. Mail Delivery – Providers save time by bypassing the U.S. mail delivery system.
  • Reduced Payer-Specific specific “Exceptions” – Industry-accepted standardized medical claim formats will tend to reduce the number of “exceptions” currently required by multiple payers.

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Electronic Submission of Claims Types

Listed below is the electronic submission of claims transactions: 

  • 837P Claim/Encounter – This is used for professional services and supplier.
  • 837I Claim/Encounter – This is used by facilities and hospitals.

Please note: Payer IDs are for both 837I (UB) and 837P (HCFA) transactions unless otherwise noted. Also, these Payer IDs are only for Kaiser Foundation Health Plan of the Northwest. If you wish to submit EDI claims to another Kaiser Permanente region, you must obtain the appropriate Payer ID from your clearinghouse or the appropriate region.

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EDI training partners

We encourage you to submit your claims electronically. Our EDI training partners are listed below:

Clearing house Payer IDs as of June 2010
Emdeon (WebMD, Envoy) 93079
Ingenix NG009 (837P)
Capario (Medavant) KS007 (837P)
Office Ally NW002
Relay Health RH002
SSI SS002
Availity Provider to contact Availity

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