Electronic Data Interchange (EDI)

All documents are in pdf format

EDI questions can be directed to:

Phone:  (401) 784-8100 for local and long distance calls or (800) 964-6211 for in-state toll calls

Email:  RI EDI Services 
For Healthcare Portal password resets, be sure to include your NPI and Trading Partner ID.


 

Electronic Secondary  Billing for Medicare and Senior Replacement Plans
Please view billing instructions if using the Provider Electronic Solutions Software.  The appropriate Carrier Codes can be found in the table below.
 

Electronic Secondary Billing for Medicare and Senior Replacement Plans
To facilitate electronic billing and proper reimbursement for Medicare and Commercial Medicare Plans (Advantage/Replacement Plans) such as United Senior Care, Blue-Chip Medicare HMO, WellCare Advantage Plan the following fields are required:

  • Loop 2320 Other Subscriber Information SBR09 - Must contain MA or MB as appropriate for the claim filing indictor
  • Loop 2320 Claim Level Adjustments CAS segment - Must contain Deductible PR 1 or Coinsurance of PR 2
  • Loop 2320 Coordination of Benefits (COB) Payer Paid Amount – Must contain the Amount Paid (other insurance paid amount)
  • Loop 2330B Other Payer Name (Carrier Code) Segment NM109 Other Payer Primary Identifier – Must contain the appropriate carrier code, see below for a list:

MDA/MDB – Medicare

22A – Aetna Medicare Advantage Plan

06A – United Senior Care

24A – Connecticare Medicare Advantage Plan

08A – Healthfirst Medicare Advantage Plan

26A – Humana Medicare Advantage Plan

09A – HMO Blue of Massachusetts Advantage Plan

26B – Humana Medicare Advantage Dental Plan

12A – Blue Chip Medicare HMO

89A – Tufts Health Plan (PPO) Medicare Advantage Plan

18A – Wellcare Medicare Advantage Plan

C01 – CarePlus Advantage Plan

19A – MMM Healthcare of Puerto Rico Advantage Plan

C02 – Commonwealth Care Alliance, Inc. Medicare Advantage Plan