Set up electronic claim/RA file sharing

Electronic data interchange (EDI) setup

We accept EDI files through a direct connection via SFTP (secure file transfer protocol, also known as FTP over secure shell) and through clearinghouses.

Companion guides

Priority Health doesn't publish companion guides, as we strictly adhere to HIPAA standards. Refer to Washington Publishing for X12 guides.

Registration forms

Claim service receipts

Service receipts summarize the number of claims submitted to Priority Health, including upfront rejections.

  • They are sent directly to your office by email, fax or US mail, as selected by your office.
  • The report lists any claims rejected up front for invalid or missing data elements.

Transaction types available for EDI

  • 270, Eligibility requests, batch and real time
  • 271, Eligibility responses, batch and real time
  • 276, Claim status requests, batch and real time
  • 277, Claim status responses, batch and real time
  • 277CA, Claim acknowledgment
  • 278, Authorizations
  • 834, Group enrollment
  • 835, Payment/Remittance advice
  • 837P, 837I and 837D, Claims
  • 999, Functional acknowledgements

Real-time transaction exceptions

Eligibility and claim status transactions are both available 24/7, with these exceptions:

  • Regularly scheduled maintenance periods, which occur on the second weekend of each month.
  • Non-routine downtime periods, which are published a week in advance.
  • Unscheduled downtime periods, which are communicated within an hour directly to clearinghouses and/or trading partners who utilize real time services.

Questions?

Email the Priority Health EDI team at edisetup@priorityhealth.com.