Electronic Data Exchange (EDI)

Why EDI?

At Health Choice Utah, we accept both electronic and paper claims from providers. To help you improve your efficiency and claim accuracy so that you can focus on patient care, we highly encourage you to submit claims electronically by utilizing Electronic Data Interchange (EDI).

The benefits of EDI are:

  • Faster transaction time and payment.
  • Reduced operational costs compared to paper claims (printing, collating, postage, etc.).
  • Increased accuracy resulting from validation of data elements.
  • Reduced adjustments.

Utah Health Information Network

Health Choice Utah is a member of the Utah Health Information Network (UHIN), a non-profit coalition of payers and providers in Utah. UHIN members have come together to reduce the administrative costs of health care through standardizations of electronic interactions.

For more information about UHIN, visit their website: www.uhin.org.

Health Choice Utah’s trading partner number with UHIN is HT006998-001.

Enrollment

All HIPAA-compliant transactions with Health Choice Utah must be submitted through the Utah Health Information Network (UHIN).

Trading Partner Registration

*If currently submitting through a clearinghouse it is not necessary to register with UHIN. Established clearinghouses already have a trading partner number set up to submit electronic transactions through UHIN to Utah payers.

If you are not submitting your claims through a clearinghouse you can obtain a trading partner ID through UHIN. UHIN does offer all the HIPAA compliant transactions. Go to https://uhin.org/new-account-setup to start the enrollment process. Follow the steps listed on the website.

EDI Enrollment Process for the 835 and EFT

Prior to 11/01/2021, Health Choice Utah was able to separate out 835’s (Electronic Remittance Advice) and EFT’s.

Effective 11/01/2021, Health Choice Utah (HCU) has migrated to an updated claims processing platform. One limitation of this platform is that the 835 and EFT must be sent together.  As a result, HCU providers must be enrolled on the 835 (Electronic Remittance Advice) in order to receive EFT’s.

Please contact the HCU EDI department with any questions at edi@healthchoiceutah.com

 

 

Please start ERA enrollment through your clearinghouse. They will then submit the form to Health Choice Utah on your behalf.
A Provider must be enrolled with the 837 to receive the 835 and EFT transaction. The 835 and EFT transactions are linked together by the Billing Provider NPI and a Provider must enroll in both transactions.

Once HCU has received the EDI Enrollment form, HCU will begin setting up the EDI connections. The provider will be notified by email once the setup is complete.

Questions?

Any EDI enrollment questions can be sent to edi@healthchoiceutah.com

Submitting Claims

EDI Enrollment Process for the 835 and EFT

There are several different options for submitting claims to HCU. These include the following:

  • MYUHIN        – Web portal through UHIN to send claims and retrieve all acknowledgment reports and remittance advice
  • clearinghouses – UHIN has a connection to most national clearinghouses and supports all HIPAA-compliant billing software.

The Payer ID for Health Choice Utah = 45399

Please Note: Payer ID numbers are assigned by the clearinghouse. As Health Choice Utah does not assign or maintain these numbers, please contact your clearinghouse for this information.

Hours & Schedule

Claims can be submitted 24/7.

UHIN Customer Service: (877) 693-3071
Hours: M-F 7:00 a.m. – 6:00 p.m. with 24/7 emergency support

EDI Support:
Fax: (801) 758-3120
Email: edi@healthchoiceutah.com

Tips for Submitting Claims

Corrected Claims:
Health Choice Utah can accept corrected claims by EDI and Health Choice Utah prefers to receive claims by EDI.

  1. Claim Header Level: Place a code 7 in the CLM05-3 segment (see 5010 Implementation Guides on Claim Frequency Type Code, page 161)
  2. Please include the original claim number being corrected.

Notes:
Claim notes, claim line notes (professional claims only) and claim billing notes (institutional claims only) can be submitted in the electronic file. HCU will not know if the claim note(s) affect the claim payment, therefore HCU will pend any claims with claim notes for review. If the notes you are submitting do not affect claim payment the claims will take longer to process as they will require manual review, so we ask that you limit claim notes to only information such as:

  • Accident details
  • Auto or subrogation detail
  • Any special circumstances

You can find more information about claim and claim line notes on page 211 and page 415 of the Professional Implementation Guide. You can find more information about claim notes and claim billing notes on pages 180 and 182 of the Institutional Implementation Guide.

Forms

EDI Form for 835, 837 (Trading Partner Setup) & EFT Enrollment (Electronic Funds Transfer)