All electronic data interchange (EDI) transmissions for Ohio Medicaid Managed Care membership must be submitted to the Ohio Department of Medicaid (ODM).

 

Please note:

  • Commercial and Medicare Ohio policies with Anthem Blue Cross and Blue Shield (Anthem) will continue to be submitted to Availity.* Only specific Ohio Medicaid polices will be submitted to ODM.
  • Availity will reject Ohio Medicaid EDI submissions on their response reports if received.

 

EDI trading partner:

  • If your organization uses practice management software, you must register as a trading partner with
  • If your organization uses a vendor or clearinghouse, please work with them to ensure they are a trading partner with ODM.

 

Registration and contact information:

 

EDI transactions through ODM:

  • Healthcare Claim: Professional (837P)
  • Healthcare Claim: Institutional (837I)
  • Healthcare Claim: Dental (837D)
  • Healthcare Eligibility Benefit Inquiry and Response (270/271):
    • Availity can be used for your real-time requests.
  • Healthcare Services Prior Authorization (278)
  • Healthcare Services Inpatient Admission and Discharge Notification (278N)
  • Healthcare Claim Payment/Advice (835)
  • Healthcare Claim Status Request and Response (276/277):
    • Availity can be used for your real-time requests.
  • Medical Attachments (275)

 

EDI payer ID for Anthem:

  • 0002937: medical claims
  • D002937-dental claims
  • V002937-vision claims
  • T002937-transportation claims

 

Electronic remittance advice (835)

  • The electronic remittance advice (835) must be registered with ODM for the Ohio Medicaid plan; Please work with your vendor or clearinghouse to enroll your 835’s with ODM
  • 835 Enrollment Instructions
  • 835 Enrollment Form
  • 835 files will be delivered to ODM.
  • Paper Remittance Advice Images can be viewed in Availity under Payer Spaces > Remit Inquiry
  • Ohio Commercial and Medicare policies with Anthem Blue Cross and Blue Shield will continue to be registered and managed by Availity.

 

Note: If you use a clearinghouse or vendor, please work with them on ERA registration and receiving your ERAs with ODM.

 

Electronic funds transfer

Electronic funds transfer (EFT) is a secure and fast way to receive payment, reducing administrative processes. An EFT deposit is assigned a trace number that is matched to the 835 ERA for simple payment reconciliation.

 

Use EnrollSafe (https://enrollsafe.payeehub.org) to register and manage EFT account changes.


* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield.

OHBCBS-CD-004187-22



Featured In:
February 2023 Anthem Provider News - Ohio