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Electronic Data Interchange (EDI)

PW_AD069621
 
 
 
Welcome to Empire’s E-Solutions page. 
Contact Information  
E-Solutions 
Phone: (800) 470-9630 
Hours: 8:00 – 4:30 ET M-F  
 
Empire offers a range of electronic connectivity services to suit the various technology needs of our providers. The information on these web pages is provided as a courtesy to you. While we try to keep the information as accurate as possible, we disclaim any implied warranty or representation about the accuracy, completeness, or appropriateness of the information for a particular purpose. Persons accessing this information assume full responsibility for the use of the information and agree that Empire is not responsible or liable for any claim, loss or damage arising from the use of or reliance upon the information contained on these web pages or inability to access this site.  
The information is designed for educational purposes only and is not legal advice and should not be used as a substitute for legal or other professional advice. Each person should consult with counsel, as appropriate, concerning the applicability of this information to the particulars of their situation.  
What is EDI? 
Electronic Data Interchange (EDI) is the computer-to-computer transfer of business-to-business document transactions and information between trading partners. Many healthcare partners, payors, vendors and fiscal intermediaries choose EDI as a fast, inexpensive, and safe method for automating the business processes that take place.  
Are there standards for exchanging information in healthcare EDI?   
The constituencies involved in health care, including healthcare partner organizations, payors, benefit plan sponsors, financial institutions and others have jointly developed and approved specific transaction sets, or standards, for use in sending and receiving healthcare information and transactions electronically. These EDI transaction sets and their associated approved American National Standards Institute (ANSI) ASC X12 transaction set numbers are listed below. 

Transaction Name  
ASC X12 Transaction 
Reference
Implementation Guide (IG)
Washington Publishing Co. 
 
Health Care Claim (Institutional, Professional) 
837I, 837P 
www.wpc-edi.com/hipaa  
Health Care Claim Payment / Advice (ERA)  
835  
www.wpc-edi.com/hipaa  
Health Care Eligibility  
270/271   
www.wpc-edi.com/hipaa  
Health Care Claim Status  
276/277   
www.wpc-edi.com/hipaa  
Health Care Prior Authorization 
278  
www.wpc-edi.com/hipaa  
 
What are the benefits derived from using these standards?  
Keeping healthcare affordable to the end consumer.
Improving accuracy of information exchanged between healthcare participants, improving the quality of healthcare delivery and its supporting processes.
Making enhanced information available to all healthcare participants as appropriate. This access ensures fast, reliable, accurate, secure and detailed information on patients and healthcare partner plans.
 
For more information click on the links below: 
 
National Government Services (NGS) – for Medicare Part A & Part B trading partners 
Empire BlueCross BlueShield Commercial Business – for trading partners enrolled to exchange electronic transactions via the Empire NY Gateway 
Combined Electronic Remittance Advice (ERA)/Electronic Funds Transfer (EFT) or EFT only registration  
Providers seeking to register or manage account changes for EFT only, or EFT and ERA combined, will need to use the Council for Affordable Quality Health Care (CAQH) Enrollment Tool , a secure electronic ERA/EFT registration platform. This tool will help eliminate the need for paper registration and reduce administrative time and costs and allow you to register with multiple payers at one time. 
Providers previously registered with us to receive combined ERA/EFT or EFT (only) will register with CAQH to manage account changes, but otherwise do not need to take action. Paper registration forms for combined ERA/EFT or EFT (only) are being discontinued and are no longer available. 
 
ERA (only) Online Registration  
Providers or their third party billing agents (e.g. billing vendor or clearinghouse) will use these links to register and manage account changes for ERA only. The CAQH enrollment process must be used for providers seeking to enroll for EFT or ERA/EFT combined.  
Providers and all other entities may use the link below. Providers who have previously registered for EFT using the CAQH process for EFT should add ERA to their CAQH profile using the CAQH process. Please do not submit duplicate requests using multiple form submission methods.

ERA registration E-Form

Manage suppression (turn off) of your paper remittance vouchers here.
Clearinghouses may opt to submit registration requests on behalf of their clients. If a clearinghouse wishes to provide this service to their clients, a user ID and password will be required. The clearinghouse should contact EDI for additional information on requirements and needed information. NOTE: Only registrations submitted by a clearinghouse with login credentials can be checked using the status tool.

Clearinghouse ERA registration

Clearinghouse ERA registration status

 
Electronic Data Interchange (EDI) Registration Form – This form can be used to register for any supported EDI transaction. 
The CAQH enrollment process must be used for providers seeking to enroll for EFT or ERA/EFT combined. 
Trading Partner Agreement – Required to be signed/acknowledged before exchanging any supported EDI transaction 
Approved Clearinghouse & Vendor Listing – Required for choosing approved clearinghouse organizations that have successfully tested electronic transactions via the Empire NY Gateway 
 
Free On-Line HIPAA Validation Testing – An on-line tool for direct EDI submitters to utilize for HIPAA transaction and code set testing. 
 
HIPAA Validator Testing Guidelines – Guidelines for using the HIPAA Validator  
 
 
Physician Online Services – Option for exchanging electronic transactions – member search, claims submission, payment, and Precertification.  
 
HIPAA – Latest HIPAA News and Resources  
NPI FAQs – Latest NPI News  
EDI Communications – Latest EDI Publications  
5010 – Latest 5010 News  
Latest News - Alerts, reminders, important EDI announcements  
 
What are the Payer Codes for Empire 1000B NM109 and 2010BB NM109? 

  Professional Institutional
Empire Blue 
00803 
00303 
 
What payer ID code do I use?
If you submit electronic claims/transactions directly to Empire Blue, please use the applicable code listed above. If you submit through a clearinghouse or use a software vendor, you should check with them for the correct value that should be used. Many clearing agencies use proprietary values therefore we do not assign or maintain payer ID codes for other entities, clearinghouses or vendors.  
©2014 Empire BlueCross BlueShield

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