EDI Tool Kit Introduction

The information provided in this tool kit will guide you through the process to begin submitting your Affinity claims electronically.  In this tool kit, you should find everything you will need to get you prepared and to ensure a smooth transition.  Our goal is to simply and clearly communicate the steps providers must take in moving from paper claim submissions to electronic submission of Affinity Health Plan claims.  To keep this tool kit simple, and to address the needs of the majority of providers, some assumptions were made:

• Providers have been exposed to EDI and HIPAA transaction requirements, and/or have access to technical resources through their billing service, billing system vendor, or Information Services department, who can provide the necessary expertise and support to work through this transition.
• The majority of our providers are already using the Emdeon clearinghouse, either directly or through a claim processing vendor, to transmit EDI claims to other payers.
• Providers are able to submit claims to Emdeon in (a) the HIPAA-compliant ANSI X12 837 format, (b) the National Standard Format (NSF +), or (c) Emdeon's HCDS + format.

If these assumptions are not valid in your case, please contact Affinity Health Plan's EDI Team at 718.794.7592 or edi@affinityplan.org to discuss your unique circumstances, and how best to accomplish the goal of EDI claim submission.

We hope this tool kit is helpful to you, and we encourage you to contact us with any questions you have about EDI claim submission. Please use the following contact information to assist in guiding you through the transition to EDI claim processing.

Affinity Health Plan - EDI Team, 718.794.7592 or edi@affinityplan.org

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