24-478 Learn How Electronic Data Interchange Helps Your Practice Work More Efficiently
Date: 05/30/24
Go paperless and use EDI technology to submit claims, receive electronic remittance advice and electronic funds transfers to your account
Electronic Data Interchange (EDI) has a variety of tools to help you track electronic claims status, improve timely filing and access daily accept/reject reports. This converts to easier receivables and account reconciliation.
When you use our approved vendors and clearinghouses, Health Insurance Portability and Accountability Act (HIPAA) compliance is done for you and gives you automatic access to highly secure and time-tested solutions. This cuts down on the time spent ensuring HIPAA compliance and problem-solving claim issues.
How it works
Successful EDI claim submission requires the use of electronic reporting made available through your vendor and/or clearinghouse. Health Net returns claims acknowledgements to the clearinghouse with notifications of acceptance or rejection of individual claims. You can review these reports to check the status of their submission.
Submit claims through Availity and Ability
Health Net contracts with Availity to provide claims clearinghouse services for Health Net claim submissions. Availity will work with your clearinghouse or vendor to get the claims submitted to Health Net in a timely manner.
Even the smallest practice can take advantage of EDI savings through our partnership with Ability (MD Online) – at no charge.
Refer to the table below for contact information and payer identification numbers for these clearinghouses.
Clearinghouse | Contact information | Payer ID |
|---|---|---|
Ability (MD Online) | 95567 | |
Availity | 68069 |
Register for electronic remittance advice
Physicians and other providers can also register to receive an electronic remittance advice (ERA). This feature reduces administrative work and claims-related problems.
- ERAs give providers details regarding multiple claims.
- They improve providers' business office workflow by allowing the adjudicated claim information to automatically post to accounts receivable systems.
- ERAs are sent to any provider who registers with either Ability or Availity and are available in all Health Net service areas.
- Register online for ERA.
Register for electronic funds transfer
Electronic funds transfer (EFT) automates the distribution of funds into providers' accounts, allowing money to be moved from one account to another.
- EFT is safe, secure, efficient, and less expensive than paper check payments and collections.
- Register online for EFT.
Note: ERA and EFT require separate registration. You can register for just ERA, just EFT or both.
Use Payspan® to enroll in ERA and EFT for certain plans
Payspan, now part of Zelis, provides electronic fund transfer (EFT) and electronic remittance advice (ERA) delivery service at no cost to providers serving Individual & Family Plans (Ambetter HMO/PPO) and Individual Medicare Advantage members.
To enroll, you will need a unique registration code that can be requested by any of the following methods:
- Online registration with PayspanExternal Link.
- Via email.
- Contact Payspan Provider Services at 877-331-7154, option 1.
Registration codes requested online or via email will be emailed from Payspan along with detailed registration instructions.
More information
For EDI-related questions, please email or call 800-225-2573, ext. 6075525.
Visit EDI website for more details about EDI and how it can help you and your practice.
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal. Behavioral health providers can call 844-966-0298.
This information applies to Physicians, Participating Physician Groups (PPGs), Hospitals, Ancillary Providers, Community Supports (CS) Providers, Enhanced Care Management (ECM) Providers, and Behavioral Health Providers.
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.