HIPAA transactions

We support all HIPAA-compliant electronic transactions. As a component of The Health Insurance Portability and Accountability Act (HIPAA), it is required that all medical records, billing and patient accounts meet consistent documentation, handling and privacy standards.

Getting started with electronic data interchange (EDI)

The companion guides below include specific details for the EDI transactions we offer and support. If you are interested in submitting electronic transactions to WellFirst Health, download and complete the applicable EDI setup form(s) below. The EDI setup forms below are fillable PDFs. Complete the EDI set up forms by filling them out electronically and saving the file. Once completed, send the PDF as an attachment in an email to edi@wellfirstbenefits.com.

Transaction Number: 270/271 Alternative to EDI requests and responses:
Benefit eligibility can be confirmed real-time through our Provider Portal. Visit Provider Resources for additional information on the Provider Portal and to find your Provider Network Consultant who can help you enroll.
EDI Transaction Number: 837 
•    Download companion guide
•    Download EDI setup form

Alternative to EDI claim submission:
We have partnered with Smart Data Solutions to offer claim submissions by manually keying in the claim information and submitting them electronically through the Smart Data Stream Clearing House Portal. There is no cost for providers or trading partners who submit claims using this portal.

Rejected claims can also be corrected and resubmitted through this portal. Register by contacting Smart Data Solutions at 855-297-4436 or online through the Account creation page for payer enrollments webpage.
EDI Transaction Number: 277 Alternative to receiving 277CA EDI responses:
Claim acknowledgment (for if claims were accepted or rejected for adjudication) can be confirmed through our Confirmation Reports Portal. Visit Provider Resources for additional information on the Confirmation Reports Portal and to find your Provider Network Consultant, who can help you enroll.

 
EDI transaction number: 276/277 Alternative to EDI requests and responses:
Claim status (for claims accepted for adjudication) can be confirmed real-time through our Provider Portal. Visit Provider Resources for additional information on the Provider Portal and to find your Provider Network Consultant who can help you enroll.
Transaction Number: 835

We work with Change Healthcare to exchange both paper explanation of payments and checks as well as electronic remittance advices and electronic funds transfers. Enroll with Change Healthcare ePayment Services at 866-506-2830 or online through their Enrollment Services webpage.

Alternative to receiving the electronic remittance from Change Healthcare:
Providers can download a copy of their electronic remittance through our Provider Portal. Visit Provider Resources for additional information on the Provider Portal and to find your Provider Network Consultant, who can help you enroll.

Transaction testing process

We test all trading partner transactions before moving into a production environment. Below are the steps we take when testing a transaction:

  • Create test folder on FTP server for trading partner
  • Test trading partner files with OPTUM Transaction Testing Service to ensure transactions are valid.
  • Work with trading partner to eliminate all OPTUM identified errors
  • Process transaction in test environment to ensure accurate results
  • Set up production folder for trading partner on FTP Server.


More HIPAA information

Centers for Medicare and Medicaid Services
Washington Publishing Co.
Workgroup for Electronic Data Interchange


Scheduled downtime

Weekly:

  • 8 pm to 11 pm Thursday – Our Plan weekly changes.  This may result in intermittent outages for real-time transactions.


First weekend of every month:

  • 8 pm Sunday to 12 am Monday - Our Plan systems maintenance. This can result in intermittent outages for all real-time transactions.


Third weekend of every month:

  • 8 pm Saturday to 2 am Sunday – Vendor monthly systems maintenance. This can result in intermittent outages for all real-time transactions.
  • 9 pm Saturday to 1 pm Sunday – Vendor monthly systems maintenance. This can result in intermittent outages for real-time transactions related to Medicare Advantage plans.
  • 6 pm Sunday to 12 am Monday - Our Plan systems maintenance. This will affect all real-time transactions.


Contact us

If you have any questions, contact the WellFirst Health EDI Team at edi@wellfirstbenefits.com or 800-356-7344, ext. 4320.