Affinity Health Plan

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    EDI Claim Submission Requirements

    There are several formats that are accepted by Emdeon for EDI claim submission.

    ANSI X12 837 4010 This is the HIPAA standard submission format. There are two types: 837I for institutional claims and 837P for professional claims.
    NSF + This National Standard Format was the accepted standard before the ANSI X12 837 format was created.
    MCDS This is Emdeon's proprietary format for professional claims.
    HCDS + This is Emdeon's proprietary format for institutional claims.

    Emdeon Submission Requirements

    Use the appropriate Emdeon Requirements document(s) listed below to format your EDI claims for electronic submission to Affinity Health Plan.

    Emdeon 837 Provider Companion Guide

    Emdeon NSF + Requirements

    Emdeon HCDS + Requirements

    Affinity Health Plan Submission Requirements

    In addition to the requirements listed in the Emdeon Companion Guide, the following information, unique to Affinity Health Plan claims, must be provided and properly formatted in the EDI file.

    837 Professional (837P)

    Loop/Segment Name Recommendations
    2010AA Billing Provider  
    NM1 08   "XX"
    NM1 09   Billing NPI
         
    REF01   "EI"
    REF02   Tax ID Number
         
    REF 01   "SY"
    REF 02   Social Security Number (Tax ID)
         
    2010BB    
    MN1 09 Affinity Payer ID "13334"
         
    2310B Rendering Provider  
    NM1 08   "XX"
    NM1 09   Rendering NPI
         
    REF 01   "EI"
    REF 02   Tax ID Number
         
    REF 01   "SY"
    REF 02   Social Security Number (Tax ID)
         
    REF 01   "0B"
    REF 02   State License # when applicable

    837 Institutionsal (837I)

    Loop/Segment Name Recommendations
    2010 AA Billing Provider  
    NM1 08   "XX"
    NM1 09   Billing NPI
         
    REF 01   "EI"
    REF 02   Tax ID Number
         
    REF 01   "SY"
    REF 02   Social Security Number (Tax ID)
         
    2010 BB    
    NM1 09 Affinity Payer ID "13334"
         
    2310 B    
    NM1 08   "XX"
    NM1 09   Rendering NPI
         
    REF 01   "EI"
    REF 02   Tax ID Number
         
    REF 01   "SY"
    REF 02   Social Security Number (Tax ID)
         
    REF 01   "0B"
    REF 02   State License # when applicable

    Other than the 4010A1, the formats listed below (NSF+ and HCDS+) are the only other formats for submitting claims with NPIs to the Emdeon clearinghouse. Affinity Health Plan urges providers to use the 4010A1 format for their electronic claims submissions.

    NSF + (National Standard Format)

    Field Name Description NSF Record, Field Location
    Payer ID "13334" Record DA0, Field 07
    Billing Provider Tax ID Tax ID Qualifier = E Record BA0, Field 08
      Tax ID Record BA0, Field 06
    Billing Provider NPI NPI Record BA0, Field 17 pos 150-164
    Rendering Provider Tax ID Tax ID Record EA0, Field 25
    Rendering Provider NPI NPI Record EA@, Field 41 pos 286-295
    Rendering Provider NPI NPI Record EA0, Field 52 pos 302-311

    HCDS + (Institutional)

    Field Name Description NSF Record, Field Location
    Payer ID "13334" Record 30, Field 05
    Billing Provider Tax ID Tax ID Record 10, Field 04
    Billing Provider NPI NPI Record 10, Field 04 pos 8-17
    Rendering Provider NPI NPI Record 46, Field 12 pos 70-84
    Attending Provider Tax ID Tax ID Qualifier = FI Record 80, Field 04
      Tax ID Record 80, Field 05
    Attending Provider NPI NPI Record 80, Field 05 pos 27-36
    Operating Provider NPI NPI Record 80, Field 12 pos 82-91
    Other Provider NPI NPI Record 80, Field 20 pos 139-148