Electronic Data Interchange (EDI)

Wellpoint uses Availity as its exclusive partner for managing all electronic data interchange (EDI) transactions. EDI, including electronic remittance advices (ERAs) and electronic funds transfers (EFTs), allows for a faster, more efficient and cost-effective way for providers to do business.

 

EDI lets you:

• Process claims faster by submitting electronically and fixing errors early with in-system notification and correction
• Reduce overhead and administrative costs by eliminating paper claim submissions
• Upload files through file transfer protocol (FTP) or directly in Availity as a batch or single claim submission
  

For Wellpoint in Availity, you can complete the following HIPAA transactions:

 

837P: Healthcare Claim: Professional

837I: Healthcare Claim: Institutional

837D: Healthcare Claim: Dental

270/271: Healthcare Eligibility Benefit Inquiry and Response

278: Healthcare Services Review and Response

278: Healthcare Services Inquiry and Response

835: Healthcare Claim Payment/Advice

276/277: Healthcare Claim Status Request and Response

275: Medical Attachments

 

 

 

Ways you can use EDI with Availity

Availity’s EDI clearinghouse options:

• EDI clearinghouse for direct submitters
  
  • For organizations with fewer than 10,000 monthly transactions
    
  • Submit batch files through the portal or secure file transfer protocol (SFTP) usingthird-party software such as billing software
• EDI clearinghouse for high-volume trading partners

Or use your existing clearinghouse vendor:

• Work with your vendor to ensure connection with the Availity EDI Gateway

 

 

 

Payer ID

 

Payer IDs route EDI transactions to the appropriate payer.

 

 

Payer Name and ID

Your payer name is WELLPOINT, and the payer ID is WLPNT.

 

Note: If you use a clearinghouse, billing service or vendor, please work with them directly to determine payer ID. These may be different when submitting Wellpoint EDIs in Availity.

 

 

 

Electronic remittance advice (835)

The 835 eliminates the need for paper remittance reconciliation.

Use Availity to register and manage ERA account changes with these easy steps:

• Log in to Availity
• Select My Providers > Enrollment Center > ERA Enrollment

Note: If you use a clearinghouse or vendor, please work with them on ERA registration and receiving your ERAs.

 

 

 

Electronic funds transfer (EFT)

Electronic claims payment through electronic funds transfer (EFT) is a secure and fast way to receive payment, reducing administrative processes. EFT deposits are assigned a trace number that is matched to the 835 Electronic Remittance Advice (ERA) for simple payment reconciliation.

 

As of November 1, 2021, use enrollsafe.payeehub.org to register and manage EFT account changes.

 

 

 

Electronic Data Interchange Trading Partner

The trading partner such as clearinghouse, billing company and vendor connects with Availity’s EDI Gateway to send and receive EDI transmissions easily.

 

 

 

Already have an Availity login but want to submit EDI transactions?

 

Log in to Availity 

1. Choose My Providers then select Enrollments Center then select Transaction Enrollment.
   
2. Follow the steps to enroll as a trading partner.