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Submitting a Claim Electronically

Specifications to submit claims electronically to HealthPlus are outlined as follows:

  • Claim Specific File Formats Accepted:
    ANSI X-12 format (HIPAA)
    • 5010 837 (claim submissions), send using the following file extensions beginning 1/1/2012:
      • .537P (Professional)
      • .537I (Institutional)
       
  • Claim Specific File Formats Returned:
    ANSI X-12 format (HIPAA)
    • 5010 TA1 (Interchange Acknowledgement)
    • 5010 999 (Implementation Acknowledgement)
    • 277 (Claim status)
      • P277 (Proprietary 277)
      • U277 (Unsolicited 277)
    • 835s (remittance advice)

    Refer to ASC X12N 837 Professional and Institutional implementation guides for descriptions of the required fields and information required to submit electronic claims.

    On the next working day, after the file has been completed, HealthPlus will send the following 997 reports for each submitted file to the provider’s mailbox:

    • 997 Functional Acknowledgement
    • P277 Proprietary Claim Status *
    • U277 Unsolicited Claim Status file

*The P277 file can be converted to a readable format, if the file is opened using Notepad, WordPad, MS Word or other word processing program. HealthPlus accepts COB 837 claim files. 835 agreements are available upon request. The 977 and U277 files must be converted to a readable format using software provided by your vendor. HealthPlus accepts COB 837 claim files. 835 agreements are available upon request.

For initial user account set up, call the HealthPlus EDI coordinators at (810) 230-2084. You will be assigned a submitter ID number to allow you to transfer claims files. After successful testing to validate the correct installation of the tool, your system will be in production status and you will be able to submit claims to HealthPlus electronically.

For more information, contact your vendor or clearinghouse. For electronic billing questions, including how to begin electronic claims transmission, retrieve acceptance and error reports, and vendor compatibility information, please contact HealthPlus at (800) 345-9956, ext. 2084.

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