ELIGIBILITY & CLAIMS

EDI: WHAT IS IT?:

Electronic Data Interchange (EDI) is the sending and receiving of information using computer technology. Its efficiency has made it a condition of doing business in dozens of industries, including retail, transportation, health care, real estate, and government. Any standard business document that one company would exchange with another (such as a purchase order, invoice, shipping schedule, inventory inquiry, and claim submission) can be exchanged via EDI between the two parties, or trading partners.

WHAT ARE THE BENEFITS OF EDI?

  • Reduced administrative costs
  • Higher claim acceptance rates
  • Speed: Since data is moved faster and with greater accuracy, the time spent communicating with suppliers is decreased.
  • Increased Productivity
  • Audit trail of claims submissions
  • Elimination of paper documents
  • Elimination of labor-intensive tasks, such as data entry
  • Greater accuracy of information

For more information regarding EDI and electronic billing requirements, click on the following links:

  Electronic Claims Processing
  EDI FAQs  [PDF]
  EDI Fact Sheet  [PDF]
  EDI Billing Dos and Donts  [PDF]
  EDI Inquiry Form
  EDI Process Flowchart   [PDF]

If you are not submitting your own claims, please forward the Guide to your clearinghouse or other entity responsible for your transactions. If you have any questions please call our EDI Support line at 215-991-4290 or 1-888-991-9023.

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Operations Technical Support (EDI/Transaction Contact) 215-991-4290
HIPAA Project Manager (Privacy Contact) 215-991-4388
215-991-4350 Provider Service Helpline
1-888-991-9023
 
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