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