Electronic Connectivity (EDI)

EDI agreements

To learn how to get set up to submit claims to us electronically, please select the option that most closely describes your office.

You must meet our testing requirements (PDF) and complete these steps:

Complete self-testing.
Once you have completed self-testing and received three passed files for each line of business tested, call the number on the test instruction letter to begin subsystem testing. If you have not received testing instructions, please contact the EDI helpdesk at 1-800-542-0945.

Clearinghouse or service bureau

You must meet our testing requirements (PDF) and complete these steps:

Complete self-testing.
Once you have completed self-testing and received three passed files for each line of business tested, call the number on the test instruction letter to begin subsystem testing. If you have not received testing instructions, please contact the EDI helpdesk at 1-800-542-0945.

Pharmacy

To submit pharmacy claims, you should be set up to bill Medco. For technical requirements and instructions, please contact:

Learn how to get eligibility and claims status information electronically.

If you've already completed our EDI set-up process, you may need to reference documentation from time to time.

Non-payment code to standard code mapping documents:

Select a provider type to find the reference documents you need:

Physicians and other professional providers

Hospitals and other facility providers

Dental providers

Sign up for Provider Secured Services to access to patient eligibility, benefits and more.