Electronic data interchange (EDI)

Anthem Blue Cross and Blue Shield (Anthem) providers may submit medical claims, eligibility inquiries, claim status inquiries, and associated attachments using electronic data interchange (EDI) through an authorized Ohio Department of Medicaid (ODM) trading partner.

EDI lets you:

  • Process claims faster by submitting coordination of benefits electronically and fixing errors early with in-system notification and correction
  • Reduce overhead and administrative costs by eliminating paper claim submissions

HIPAA transaction codes

Providers can use the following HIPAA transaction codes and submit through the Ohio Department of Medicaid via Anthem’s Availity Portal or through an approved ODM Trading Partner:
  • Healthcare Claim: Professional (837P)
  • Healthcare Claim: Institutional (837I)
  • Healthcare Eligibility Benefit Inquiry and Response (270/271)
    • Availity can be used for your real-time requests
  • Healthcare Claim Payment/Advice (835)
  • Healthcare Claim Status Request and Response (276/277)
  • Medical Attachments (275)

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield.

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EDI submissions and enrollment

For Medical claims: All electronic data interchange (EDI) transmissions for Medical claims for Ohio Medicaid Managed Care membership must be submitted by providers to the Ohio Department of Medicaid (ODM) using approved trading partners. Please note – Availity* is a trading partner with ODM and medical claims can be submitted using payer ID 0002937.

For Dental, Vision and Transportation claims: Follow the vendor’s provider manual instructions for claim submission and reimbursement. Vendors will submit claims to the ODM Fiscal Intermediary (FI) on the provider’s behalf. Providers should not submit claims directly to ODM or through Anthem’s Availity portal.  

Registration and contact information

Email: usomesedisupport@deloitte.com

Call the Integrated Health Desk (EDI): 800-686-1516

Note: Select option 3 to speak to representative concerning EDI questions and enrollment.

Payer ID

Payer IDs route EDI transactions to the appropriate payer.

Anthem Ohio Medicaid EDI Payer ID is 0002937 — for Medical claims submitted via trading partner through ODM Fiscal Intermediary (FI)

Vendor Claim Submissions – please refer to each vendor’s provider manual.

 

Electronic remittance advice (ERA)

The 835 eliminates the need for paper remittance reconciliation. The ERA 835 must be registered with ODM for the Ohio Medicaid plan. Please fill out the 835 trading partner form and submit your EDI registration to ODM.

Providers can access their ERAs through  Availity Essentials .

Note: If you use a clearinghouse or vendor, please work with them on ERA registration and receiving your ERAs with ODM. Commercial policies with Anthem Blue Cross and Blue Shield (Anthem) will continue to be registered and managed by Availity.

Electronic funds transfer (EFT)

Electronic claims payment through electronic funds transfer (EFT) is a secure and fast way to receive payment, reducing administrative processes. EFT deposits are assigned a trace number that is matched to the 835 electronic remittance advice (ERA) for simple payment reconciliation.

Use EnrollSafe to register and manage EFT account changes.

Note: If a provider does not enroll in EFT, they will receive a paper check or virtual card.

Contact information

For more information on EDI, please refer to your provider manual , contact your Provider Services representative, or reach out to the Ohio Department of Medicaid’s EDI services.

Provider Services

Phone

Phone: 844-912-1226

EDI Customer Service

Phone

Monday to Friday 8 a.m. through 4:30 p.m. EST
Phone: 844-324-7089
 

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EDI Technical Assistance

Phone

Monday to Friday 8 a.m. through 4:30 p.m. EST
Phone: 844-324-7089

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Related information

 

Provider tools & resources

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