Submitting EDI Transactions
Types of EDI Transactions
Electronic Data Interchange (EDI) functionality is utilized by Molina Complete Care (MCC) to complete several types of ASC X12N Version 5010 transactions, including:
- Claims Submission (837 Professional and Institutional Healthcare Claims)
- Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT) – (835 Healthcare Claim Payment/Advice)
- Referral Certification and Authorization (278 Healthcare Services Review - Request for Review and Response)
- Eligibility for a Health Plan (270/271 Healthcare Eligibility Benefit Inquiry and Response)
- Claims Status (276/277 Healthcare Claim Status Request and Response)
EDI Claims Submission
The easiest way to submit EDI claims to MCC is through a clearinghouse. You may submit the EDI claims through your own clearinghouse or use MCC’s contracted clearinghouse (see the Clearinghouse Information link for Payer ID information). If you do not have a clearinghouse, MCC offers additional electronic claims submissions options. Log onto Availity's Provider Portal for additional information about claims submission options available to you.
270/271 Healthcare Eligibility Benefit Inquiry and Response & 276/277 Health care Claim Status Request and Response
MCC does not directly exchange 270/271 and 276/277 transactions. The 270/271 and 276/277 transactions are handled by MCC’s contracted clearinghouse Change Healthcare. The transactions may be sent directly to Change Healthcare or via your own clearinghouse.
278 Referral Certification and Authorization Form
The 278 Request transaction is utilized to verify medical necessity for health care services; therefore, additional supporting documentation may be necessary for approval of requested services.