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Electronic Claims Submissions (EDI), Payments (EFT), and Remits (ERA)

Benefits of Using EDI for Claim Submissions
Electronic Submission of Claims Types
Electronic Payments (EFT) and Remits
EDI Trading 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 transfer 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; therefore, 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 suppliers.
  • 837I Claim/Encounter – This is used for facilities and hospitals.

Please note: Payer IDs are for both 837I (UB) and 837P (CMS1500) transactions.

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EDI Trading Partners

We encourage you to submit your claims electronically. Our EDI trading partners, and Payer ID’s are listed below:

Clearing house Northern CA Southern CA Hawaii Georgia Northwest Mid-Atlantic Colorado
ChangeHealthcare(CHC)
94135 94134 94123 21313 93079 52095 91617
OptimumInsight/Ingenix N/A N/A N/A NG010 NG009 NG008 COKSR
Navicure
N/A N/A N/A 21313 N/A N/A N/A
Office Ally 94135 94134 N/A N/A NW002 52095 N/A
Availity (formerly REALMED)
N/A N/A N/A N/A N/A 54294 N/A
Relay Health RH009
94134
RH0011
RH008
RH002
RH010
RH003
SSI
NKAISERCA
SKAISERCA
N/A
21313
SS002
N/A
999990273

If your clearinghouse is not directly affiliated, they may re-route claims to one of our direct trading partners!

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