24-480 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, on behalf of CalViva Health, 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
The Plan 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 Plan 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.
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
Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569. Behavioral Health providers can call at 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.
This information applies to Medi-Cal in Fresno, Kings and Madera counties.