Affinity Health Plan

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  • Electronic Data Interchange (EDI) Claims Information

    If you are submitting electronic claims to Affinity for the first time and you are participating in the Affinity provider network, please: 

    » Modify the tables in your billing system to include your Billing NPI and Rendering NPI on Affinity claims

    » Review the Emdeon and Affinity Health Plan Companion Guides for 837P and 837I submissions. All data elements must be properly mapped based on the specifications identified for the format you are using

    »Modify the payer tables in your billing system to begin creating electronic claims for Affinity Health Plan:

    • For Medical Claims for Medicaid, Child Health Plus and Essential Plan Members - Affinity's payer ID is 13334
    • For Medical Claims for Medicare Advantage and Medicaid Advantage Members - Affinity's payer ID is 13333
    • For Medical Claims for Qualified Health Plan Members - Affinity's payer ID is 23334
    • For Behavioral Health Claims for All Members - Affinity's payer ID is 43324 and our Plan ID (SBR03) is 0009

    » Submit your EDI claims file to Emdeon, the Affinity clearinghouse

    » Reconcile Affinity EDI claim submissions by reviewing claim reports and verifying the claim status codes provided by Emdeon or your vendor to verify that all claims transmitted to Emdeon are processed and received by Affinity Health Plan. Also, review Remittance Advice provided by Affinity for claims submitted electronically to verify that claims transmitted to Emdeon have been successfully processed by Affinity.

    If you are submitting electronic claims to Affinity for the first time and you are not participating in the Affinity provider network, please complete the Non-Participating Provider Verification Form and return to Affinity via fax at the fax number located on the form. When we have received your information, we will set-up your file in our core system so that we may process your claims. If you are not registered in our system, we will not be able to identify your provider information and your claims will be rejected. Once we have your file established, please follow the steps above to submit your EDI claims.

    For additional EDI information, please review the EDI Frequently Asked Questions (FAQs)

    For inquiries on the process for submitting EDI claims, send an e-mail to: edi@affinityplan.org and one of our EDI specialists will respond to you within 24 hours. You can also access Affinity payer specific information via the Emdeon Clearinghouse web site at www.emdeon.com.