EDI Clearinghouses
Electronic claims submission
Electronic Data Interchange (EDI) is the computer-to-computer exchange of business data in standard formats. EDI transmissions must follow the transaction and code set format specifications required by the Health Insurance Portability and Accountability Act (HIPAA).
CareSource has invested in an EDI system to enhance our service to participating providers. Our EDI system complies with HIPAA standards for electronic claims forms. We are committed to offering you the most flexible and efficient means possible of doing business with us.
CareSource accepts electronic claims in the following file format:
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837 ANSI ASC x 12N (004010A) file format for professional and institutional claims
Benefits of Electronic Claims Submission:
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Reduces paperwork and costs associated with printing and mailing paper claims.
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Reduces time for CareSource to receive a claim by eliminating mailing time.
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Reduces delays due to incorrect claim information by returning errors directly to you through the same electronic channel. These claims can be corrected and resubmitted electronically.
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Improves accuracy by decreasing the chance for transcription errors and missing/incorrect data.
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Tracks and monitors claims through claim status reports received electronically.
EDI Clearinghouses
To submit claims electronically, providers must work with an electronic claims clearinghouse. CareSource currently accepts electronic claims from Ohio providers through the clearinghouses listed below. If you have questions about your provider billing number, please call us at 1-800-488-0134. Please provide the clearinghouse with the CareSource payer ID number: 31114.
Transition to 5010 Compliance
CareSource is moving towards federally-mandated compliance with 5010 transactions for claims. Effective January 1, 2012, CareSource will only accept claims in the 5010 format. Read more about our transition to 5010.