Oxford Health Plans > Providers Resources > Electronic Data Interchange (EDI)

Electronic Data Interchange (EDI)

EDI is an advanced form of electronic business-to-business communication that instantly links your computer system with us, other health plans, and government payers. Patient information is transferred between health care professionals and payers in a standardized, secure, and efficient manner.

With EDI you can perform the following transactions in batch or real time:

Why use EDI?

Improve cash flow
  • Confirm patient eligibility to ensure that you bill the right payer, the first time.
  • Receive immediate feedback on your claims, allowing you to correct errors at the time of initial submission.
  • Eliminate mail and handling time for your claims, which may improve your cash flow.
  • ERA/EFT saves trips to the bank by depositing payments directly into your accounts.

Reduce administrative expenses
  • Buy less ink, paper and stamps.
  • No cost and low cost clearinghouses are available.

Reduce paperwork
  • Submit the majority of your claims electronically.
  • Enter your precert and notifications electronically and eliminate the precertification-by-fax form.
  • With ERA/EFT, you no longer have Explanation of Benefits (EOB) to file or checks to deposit; the EOB/remittance information is provided online (and can be printed if desired) and payment is deposited to your bank accounts.

Reduce phone calls
  • Check eligibility and benefits at your convenience.
  • Check referrals, notifications and precertification requests without hold time.
  • Check the status of multiple claims quickly.

Options for Submitting EDI Transactions

You may opt for a free direct connection (see below) or you can choose from many available clearinghouses that are typically fee-based. You can usually sign up with one clearinghouse to connect with all your payers.

The clearinghouse you select will work with you to ensure that you can submit the required information and will translate your data into the Health Insurance Portability and Accountability Act (HIPAA)-compliant format. Your clearinghouse will need to know that the Oxford payer ID number is 06111.

OptumInsight offers a secure, easy-to-use path to virtually all commercial and government payers. For more information, visit optuminsight.com or call 1-800-765-6713.

PNT Data® gives you the ability to submit and receive Oxford HIPAA transactions free of charge. Learn more and enroll at pntdata.com or call 860-257-2030.

eSolutions Support Team

We have a dedicated team of professionals with an in-depth understanding of electronic solutions, available to assist you Monday through Friday between 8:30 am and 5:00 pm. If you have questions, issues, or just want to explore the benefits of EDI, contact us at 1-800-599-4EDI (4334).