Electronic Data Interchange (EDI)
If you currently do not submit claims electronically or need assistance, please contact one of our preferred clearinghouses (By clicking any of the links below, you will leave the CareFirst website and access a vendor website. The vendor is solely responsible for the services it provides.):
- Emdeon (formerly known as Webmd) at 866-369-8805
- Allscripts (formerly known as Payerpath) at 877-623-5706, ext. 1 or ext. 2
- RealMed at 877-927-8000, ext. 1201
- RelayHealth at 800-527-8133, option 2
Electronic Fund Transfer (EFT)
The following clearinghouses also offer electronic fund transfer (EFT) services (By clicking any of the links below, you will leave the CareFirst website and access a vendor website. The vendor is solely responsible for the services it provides.):
- Emdeon at 866-369-8805
- RealMed at 877-927-8000, ext. 1201
- Allscripts (enrollment performed by Payspan) at 877-623-5706, ext. 1 or ext. 2
- RelayHealth (enrollment performed by Payspan) at 800-527-8133, option 2
The following information is required when contacting your clearinghouse to enroll for EFT services:
- National Provider Identifier (NPI) – Billing NPI
- Provider Federal Tax Identification Number (TIN)
- Reason for Submission : New/Change/Cancel Enrollment
- Requested EFT Start/Change/Cancel date
- Practice/Provider Name
- Financial Institution Information (including Financial Institution Name, Financial Institution Routing Number, Type of Account (Checking/Savings), Provider's Account Number
With EFT transmission, CareFirst will discontinue the delivery of your paper remittance notice. Your Electronic Remittance Advice (ERA-835) will be delivered by your clearinghouse and will be your new payment voucher.
The ERA-835 will include payment details and HIPAA adjustment and remarks codes necessary for you to reconcile your patient accounts. If a copy of this information is needed, you should contact your clearinghouse.
View our EFT FAQs or contact your clearinghouse with any questions regarding specific EFT enrollment capabilities.
CareFirst has six companion guides, to be used in conjunction with the HIPAA Implementation Guides, explaining the procedures necessary for our trading partners to conduct Electronic Data Interchange (EDI) transactions. These guides will be expanded and updated as additional standard transactions are ready for testing.
Transaction standards and code sets are used to support the electronic exchange of administrative and financial health care transactions. HIPAA designates "standard" transaction formats that must be used for the following common transactions:
- Health Care Claims (837)
- Health Care Payment/Advice (835)
- Premium Payment/Order Remittance Advice (820)
- Benefit and Enrollment Maintenance (834)
- Authorizations and Referrals (278)
- Inquiry/Response for Eligibility (270/271)
- Inquiry/Response for Claim Status (276/277)
- Health Care Claim/Pharmacy NCPDP 5.1
HIPAA has also defined the code sets that will be used to classify member information. The following code sets must be used:
- Diagnoses and inpatient hospital services: International Classification of Diseases, ninth edition, Clinical Modification (ICD-9-CM)
- Institutional Services: ICD-9-CM, Volume 3 and HCFA Common Procedural Coding System (HCPCS)
- Physician Services: Current Procedural Terminology (CPT)
- Dental Services: Current Dental Terminology (CDT)
- Drugs: National Drug Code (NDC)
Inquiries regarding set-up, testing and file submissions should be directed to firstname.lastname@example.org.
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