Submitting EDI Transactions
Types of EDI Transactions
Electronic Data Interchange (EDI) functionality is utilized by Passport 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 Passport is through a Clearinghouse. You may submit the EDI claims through your own clearinghouse or use Passport’s contracted clearinghouse (see the Clearinghouse Information link for Payer ID information). If you do not have a Clearinghouse, Passport offers additional electronic claims submissions options.Log on to Availity's Provider Portal for additional information about claims submission options available to you.
270/271 Healthcare Eligibility Benefit Inquiry and Response & 276/277 Healthcare Claim Status Request and Response
Passport does not directly exchange 270/271 and 276/277 transactions. The 270/271 and 276/277 transactions are handled by Passport’s contracted clearinghouse Change Healthcare. The transactions may be sent directly to Change Healthcare or via your own clearinghouse. *New York Providers will continue to submit transactions through Claimsnet.
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.278 - Request for Review and Response