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For Providers

Filing Electronic Claims

UniCare complies with HIPAA 5010 Transaction Standards and Code Sets, and with the electronic data interchange (EDI) standards for health care required by the Health Insurance Portability and Accountability Act (HIPAA).

Electronic Data Interchange (EDI) is the computer-to-computer transfer of transactions and information. We encourage providers to submit claims electronically to improve productivity and efficiency.

UniCare now has a strategic partnership with Availity to serve as our designated EDI gateway for all electronic data and transactions.

Providers, billing services, and clearinghouses that wish to establish a direct connection can register to exchange EDI transactions at www.availity.com.

The electronic Payor ID number for the UniCare State Indemnity Plan is 80314.

Electronic transaction documents for UniCare claims

Check the data content requirements when exchanging electronically with UniCare. Scroll down to Section B – Transaction Specific Companion Documents. These instructions apply to all transaction types.

Code sets

Providers are required to bill with valid code sets. Please reference these sites for the most recent code set information:

These are third-party sites operated by independent entities over which UniCare has no control or right to control. UniCare makes no representations or warranties about the accuracy or validity of the information provided at these sites. You agree to these terms and conditions when you exit this site and link to the other site.

ERA registration

As of June 1, 2018, please use Availity to manage account changes and new registrations for electronic remittance advices (835). Please check your organization to ensure you do not have an existing account.

For any questions, please contact Availity Client Services at 800-AVAILITY (282-4548).

EFT registration

To register or manage account changes for electronic funds transfers (EFT) only, use the EnrollHub™, a CAQH Solution™ enrollment tool, a secure electronic EFT registration platform. This tool eliminates the need for paper registration, reduces administrative time and costs, and allows you to register with multiple payers at one time.

If you were previously registered to receive EFT only, you must register using EnrollHub to manage account change.

Important! How to submit a corrected claim to avoid rejection

To prevent your corrected claim from getting rejected as a duplicate claim, ask your software vendor to do the following:

If you file your claims using free web-based transactions without a vendor, you should also follow the above steps when submitting corrected claims to avoid the claim getting rejected as a duplicate.

Trading partners can also purchase the full Technical Report Type 3 (TR3) guides from Washington Publishing Company.

Get more information

For more information about UniCare electronic claims, call UniCare e-Solutions at 800-470-9630 Monday through Friday from 8:00 a.m. to 4:30 p.m. Pacific time.

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For self-funded plans, claims are administered by UniCare Life & Health Insurance Company. © 2018 UniCare