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Electronic Data Interchange (EDI)

Electronic claim submission increases accuracy because claim information received is loaded directly into our system. We can also receive coordination of benefits (COB) claims and corrected bills electronically.

The language used in electronic transactions is called X12 and is subject to national standards. We support a variety of EDI transactions (see below) and require all external trading partners to submit these transactions through the Utah Health Information Network (UHIN).

Go to UHIN

Payer ID List

Select Health does not have a single payer ID; however, you can access a Payer ID List that aligns common software/clearinghouse information with the payer ID each uses for Select Health. If the clearinghouse has a search function, we can be found under the name “Select Health,” or possibly under one our former names, “Intermountain Health” or “IHC Health Plans.” 

Download the Latest Payer ID List

Transaction Types

Click below to read more about each type of transaction.

Use the 837 transaction to submit claims electronically, which allows for faster adjudication and payment. The 837 generates responses that tell you if claims were accepted or rejected and, if necessary, the reason for the rejection. The two responses generated are:

  • The Functional Acknowledgement (999) ‒ This transaction contains details about submissions, including the accepted/rejected status and reason(s) for rejections. A rejection will not progress and must be corrected and resubmitted for consideration. If you receive a status that indicates there was an error in your file and are unsure to which claim an error applies, please contact us.
  • The Healthcare Claims Acknowledgement (277CA) ‒ For all claims accepted in the 999, this transaction provides information regarding the accept/reject status of claims based on our internal requirements. If a claim rejects on the Healthcare Claim Acknowledgment, it requires correction of the inaccurate data and resubmission to be considered. You may receive more than one rejection for a claim.

Within this transaction, reported claims are assigned a category code, status code, and entity code as follows:

Category Code
Status Code
Identity ID Code
Description
A2
19
40
Claim accepted in our adjudication system
A3
153
HK
Claim Rejected: Subscriber Not Found
A3
158
03
Claim Rejected: Dependent Not Found
A3
125
03
Claim Rejected: Dependent Not Found
A3
54
40
Claim Rejected: Duplicate Claim
A3
562
40
Claim Rejected: Missing or Invalid NPI Number
A3
88
QC
Claim Rejected: Patient Not Eligible
A3
255
Claim Rejected: Diagnosis Code

This transaction helps verify a member's eligibility and benefit information without having to contact Member Services. The 271 response contains information on eligibility, eligibility dates, copays, coinsurance, deductibles, out-of-pocket maximums, visit limits, and benefit limits.

If a 270 is submitted as a real-time transaction, the 271 response will be received within 20 seconds.

For more information, download the Centers for Medicare and Medicaid Services (CMS) 270/271 Health Care Eligibility Benefit Inquiry and Response Companion Guide for Mandatory Reporting Non-GHP Entities.

This transaction helps verify the status of a specific claim. The 277 response includes the:

  • Current status (i.e., received, pended, or finalized) and status dates
  • Paid amounts and payment information once finalized

If a 276 is submitted as a real-time transaction, the 277 response will be received within 20 seconds. For more information, download the CMS Standard Companion Guide Health Care Claim Status Request and Response (276/277).

Select Health manages all provider payments through Zelis. If you have not done so, please enroll in Zelis using the information below. Please reach out to Zelis with questions.

 

Need help or want to enroll in Zapp Edge, ACH+, or VCC options (fee-based):

  • Phone for enroll/help: (877) 828-8770

Need help or want to enroll in standard EFT/ERA Transactions (no-fee):

What is the ERA/835 and EFT? 
  • Electronic Remittance Advice (ERA/835) details payment information on claims. The ERA, available through Electronic Data Transmission Interchange (EDI) transaction 835, is more efficient than waiting for a paper remittance advice. Most software systems can use an 835 to automatically post payments to the proper accounts.
  • Electronic Funds Transfer (EFT) deposits funds for Select Health claim payments directly into your bank account. To receive the EFT, you must also be able to accept the 835.

If you are switching to a new bank, your remittance will be dropped to paper check. For security reasons, Zelis needs to pay via paper checks for two weeks (four pay periods) before we can add a requesting provider to the new bank.

I need to set up my clearinghouse delivery with Zelis. 

Each week payments are sent as follows (subject to change):

  • Medical 835: Monday, Wednesday
  • Dental 835: Friday
  • Medical EFT: Monday, Wednesday
  • Dental EFT: Friday
  • Medical Paper Remits: Tuesday, Friday
  • Medical Paper Checks: Tuesday, Friday
  • Dental Paper Remits: Thursday
  • Dental Paper Checks: Thursday

Electronic remittance files (835s) for all payments processed by Zelis are available through the Zelis Provider Portal. 

If you have opted for electronic delivery to a clearinghouse or your practice SFTP, your 835 will be delivered within 72 business hours after your payment has settled with the bank.

If you have late or missing EFT or ERA (835) Resolutions, contact your software vendor or clearinghouse to make sure they know to send the information to you. If you have not enrolled directly through them, they may receive the ERAs but dont known where to forward them or whom to notify.

If you need help, please contact Zelis directly, using the numers at the top of this article.

If you need EDI support, please email edisupport@zelis.com of call (877) 828-8770.

Questions?

Contact the EDI team by email, phone, or fax.

Email

edi@selecthealth.org

Phone

800-538-5099

Fax