EDI refers to the structured transmission of data between organizations by electronic means. Organizations that send or receive documents between each other are referred to as "trading partners" in EDI terminology. The trading partners agree on the specific information that is to be transmitted and how it should be used.
How does Senior Whole Health use EDI?
Senior Whole Health uses a clearinghouse to send and receive electronic data for the purpose of adjudicating claims from its healthcare providers.
What is a clearinghouse?
A clearinghouse is a company that provides connectivity and often serves as a "middleman" between physicians and billing entities, payers and other health care partners for the transmission and translation of the claims information into the specific format required by Senior Whole Health to pay the claims. The following demonstrates the process:
- Physician practice
Compiles and sends a batch file using a downloadable form from the clearinghouse
Sorts, formats, and translates a batch file into a standard format
Submits claims to exclusive payer clearinghouse
- Payer exclusive clearinghouse
Translates the claim into payer format
Senior Whole Health receives EDI files through Change Healthcare.
What are the Benefits?
There are many benefits to sending your claims electronically to Senior Whole Health, including:
- Decreased data entry errors... Faster payment.
- Reduced paper claim costs... No paper claims to print.
- Lower printer costs... No ribbon or toner expense.
- Reduced mailing costs... No envelopes or stamps to buy.
- Decreased office costs... No overhead to print, sort, stuff, and mail claims.
- Increased staff efficiency... Quicker claims turnaround time.
EDI claims information is supported in two formats:
- UB-04 & UB-92 (CMS-1450) – Support Institutional Claims: Hospitals & Skilled Nurses
- CMS 1500 – Support Professional Claims: Medical Services & Health Plans
Senior Whole Health accepts the following Health Insurance Portability and Accountability Act (HIPAA) compliant claim transaction types:
- 837P - Professional Claims Submission
- 837I - Institutional Claims Submission
The 837 file format is an efficient and direct solution for billing your claims. This transaction type can be used to submit health care claim billing information, encounter information, or both, from providers to payers either directly, or via intermediary billers or for Senior Whole Health through a claim clearinghouse.
Senior Whole Health will provide a paper Remittance Advice with your claims payment.
How to get started using EDI
ON24/7 is a web-based system that allows Change Healthcare customers to submit service requests and check on the status of those requests 24 hours a day, 7 days a week. Please contact Change Healthcare directly at 1-888-363-3361 or visit the ON24/7 site.
Note: Senior Whole Health Payer ID is 83035.
How long will it take before payment is received?
Senior Whole Health processes EDI files on a daily basis. Therefore, you can generally expect payment within 10-21 calendar days of our received date. If you believe that Senior Whole Health has not processed your file within 30 calendar days of our expected received date, or you have questions about your remittance advice, please contact Senior Whole Health's Claims Department at 1-866-233-4773.
What if I need to submit supporting documentation, or a corrected claim?
In the rare case that this is necessary, please submit your corrected claim on paper with the supporting documentation to:
Senior Whole Health
PO BOX 956
ELK GROVE VILLAGE, IL 60009-0956
Last Updated 02/21/2018