Get Paid via Electronic Funds & Claims

2. Electronic transactions

Sending electronic data interchange (EDI) transactions can help claims process faster and improve your cash flow.

LifeWise supports the exchange of all transactions mandated by the Health Insurance Portability and Accountability Act (HIPAA). LifeWise can exchange transactions with you directly or through a billing service or clearinghouse.

Claim payer IDs

Claim payer IDs are used to make sure your electronic transaction is routed to the right health plan. If you're using a clearinghouse, be sure to verify all payer IDs as they might request that you use a different payer ID than those listed here.

LifeWise claim payer IDs by category

Professional, Institutional: 00430
Individual Plan Dental: 47570

Submit claims using a clearinghouse or to LifeWise directly

A clearinghouse acts as a go-between for the provider and the payer (health plan). Using a clearinghouse means you can reach multiple payers through a single vendor.

Submit directly to LifeWise EDI

Before you enroll, you'll need to check with your system vendor to confirm that your system can send in the HIPAA (x12)-required format. This option is typically used by large facilities, large provider groups and billing services.  Please email us for more information.

Using a clearing house

You can submit electronic claims to LifeWise EDI using the clearing house of your choice or the choice of your software vendor if the clearing house is enrolled with LifeWise. Check with your clearing house or software vendor on how to submit an electronic claim to LifeWise EDI. Small offices or individual providers who don't want to accrue fees from a clearing house are encouraged to use Office Ally free of charge when submitting to LifeWise EDI. Email us for Office Ally pre-enrollment information or visit www.OfficeAlly.com.

Electronic claim acceptance

 We create an accept/reject report that we share with our direct submitters and clearinghouses. Check with your clearinghouse about receiving reports.

NOTE:  Make sure your National Provider Identifier (NPI) is submitted on your electronic claim. If you are a dual-licensed provider, please ensure the appropriate taxonomy code is submitted on your claim. Taxonomy codes will need to be registered on the NPPES website. If you have questions or need to update your provider record to include your taxonomy code(s), please contact NPPES at 800-465-3203.

835 Transactions (electronic remittance) enrollment

LifeWise electronic remittance is available for all local providers regardless of contract status. To enroll with LifeWise EDI to receive electronic remittance, contact your software vendor or clearing house. If you're a direct submitter to LifeWise EDI or use Office Ally as your clearing house, you can email us to.  request the electronic remittance enrollment form.

We partner with the following EDI clearinghouses and vendors and can add a new clearing house upon review and approval.

HIPAA transactions

LifeWise also offers the following HIPAA transactions:

• 270/271—Health Care Eligibility Benefit Inquiry and Response
• 276/277—Health Care Claims Status Request and Response
• 835—Health Care Claim Payment/ Remittance Advice
• 837—Health Care Claim: Professional, Institutional, Dental
• 999—Functional Acknowledgements

Contact us for details on exchanging specific transactions other than claims.

Corrected, replacement, voided, and secondary claims

You can submit a corrected, replacement, or voided claim electronically using the HIPAA 837 standard claims transaction. Please include the following information:

• Frequency code of '7' in loop 2300, CLM05-3 segment to indicate a corrected/replacement of a previously processed claim. Use '8' to void a claim you billed in error.
• The initial LifeWise claim number (in loop 2300, REF01 must contain 'F8' and REF02 must contain the claim number).
• A free form note (highly recommended) with an explanation for the corrected/replacement claim, in loop 2300 claim note as:
  • For professional and dental claims, segment NTE01 must contain 'ADD' and segment NTE02 must contain the note, for example: NTE*ADD*CORRECTED PROCEDURE CODE
  • For institutional claims, segment NTE01 must contain 'UPI' and segment NTE02 must contain the note, for example: NTE*UPI*CORRECTED LAB CHARGES

Secondary claims via EDI

When sending us a secondary claim, please include the following required information:

1. Primary payer name
2. Primary payer member ID for the patient
3. Primary payer allowed amount
4. Primary payer payment amount
5. Primary payer reason for nonpayment (i.e., non-covered service, deductible, benefit maximum)
6. Primary payer adjudication date for claim is required

If you have questions about billing these from your system, please contact your system vendor or clearinghouse. 

Medicare note: When LifeWise is secondary to Medicare, there's no need to submit claims to LifeWise if your Medicare explanation of payment indicates the claim was forwarded (or crossed over) to the secondary payer. Submitting the claim to us will cause a duplicate.

Resources

National Uniform Claim Committee (NUCC) – Learn about mapping from the 1500 claim form to 837.

National Uniform Billing Committee (NUBC) – Get additional institutional claim information.

Contact us

Email: EDI@LifeWiseHealth.com
Phone: 800-435-2715
Fax: 425-918-4234 (for EDI enrollment forms only)
Submit paper claims, correspondence, or medical records to:
LifeWise Health Plan of Washington
P.O. Box 21552
Eagan, MN 55121