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 Prevea360 Health Plan, 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 the EDI team.

Transaction Number: 834
Alternative to EDI requests and responses
Our Employers Portal  is available for those employer groups who choose not to submit benefit enrollment and maintenance using EDI.
Transaction Number: 270/271
Alternative to EDI requests and responses:
Benefit eligibility can be confirmed real-time through our Provider Portal. Visit the provider home page for additional portal information and to find your Provider Network Consultant, who can help you enroll. 
EDI Transaction Number: 837
Alternative to EDI claim submission:
We have partnered with SmartData Solutions to offer claim submissions by manually keying in the claim information and submitting them electronically through the Smart Data Stream Clearinghouse 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 the provider homepage 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 the provide homepage for additional portal information and to find your Provider Network Consultant, who can help you enroll. 
Transaction Number: 835

We have partnered with Change Healthcare for the exchange of both paper explanation of payments and checks as well electronic remittance advices and electronic funds transfers. Change Healthcare ePayment Services can be reached at 866-506-2830. Additional informatin can be found on their Enrollment Services webpage.

Electronic Funds Transfers (EFT)
  1. Go to https://support.changehealthcare.com/.
  2. Click EFT Enrollment Forms link under the Medical/Hospital Enrollment column.
  3. Click EPayment Request Forms link.
  4. EFT request form will download.
  5. Complete the form and save a copy. We recommend checking the box for Payment Manager Authorization Form. Payment Manager is a Change Healthcare portal that allows you to make updates and download remits. 
  6. It is preferred to email the completed forms to eftenrollment@changehealthcare.com but it can be faxed to 615-238-9615. Note: The eftenrollment@changehealthcare.com email distribution is not monitored for questions or requests.
  7. Allow 15 days for processing.

Enrollment process questions can be directed to Change Healthcare ePayment Services at 866-506-2830 as your initial contact point.
 
Electronic Remittance Advices (ERA)
  1. Required to be enrolled/receiving EFT first. 
  2. Go to https://support.changehealthcare.com/.
  3. Click ERA Enrollment Forms link under the Medical/Hospital Enrollment column.
  4. In the ‘Search enrollment forms…’ search box enter 39113 and search. 
  5. 10 forms are returned. A provider only need to fill out one of the forms for Professional claims and/or one for Institutional claims. 
  6. New and existing providers will submit the same ERA enrollment form(s). Complete the form(s) and save a copy. 
  7. It is preferred to email the enrollment form to BatchEnrollment@changehealthcare.com but it can be faxed to 615-885-3713.
  8. Allow 15 days for processing. 

Enrollment process questions can be directed to Change Healthcare ePayment Services at 866-506-2830 as your initial contact point.

Alternative to receiving the electronic remittance from Change Healthcare: 
A provider can download a copy of their electronic remittance through our Provider Portal. Visit the provider homepage for additional portal information 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

Second weekend of every month:
  • 7 pm Saturday to 2 am Sunday – vendor monthly systems maintenance. This will affect all real-time transactions.


Third weekend of every month:
  • 10 pm Saturday to 11 am Sunday – vendor monthly systems maintenance.
  • 6 pm Sunday to 2 am Monday – Prevea360 monthly systems maintenance. This will affect all real-time transactions.  


Contact us

If you have any questions, contact the Prevea360 EDI Team at edi@prevea360.com or 800-356-7344, ext. 4320.