Feb 1, 2023 • State & Federal / Medicaid

Beginning February 1, 2023, your organization may begin receiving Anthem Blue Cross and Blue Shield (Anthem) membership for Ohio Department of Medicaid (ODM) policies as well as the existing Anthem commercial lines of business. This document will help identify key differences for submitting electronic transactions.

 

Electronic claim submission EDI payer ID

Ohio Department of Medicaid (ODM):

  • 0002937 - Medical

Ohio commercial (Availity*): 

  • 00834 Professional
  • 00332 Institutional


Medicaid:

  • All EDI submissions must be delivered to ODM using payer ID 0002937.
  • If you use a clearinghouse or billing vendor, please work with them to ensure connection to ODM.
  • Availity is a participating clearinghouse vendor with ODM. Your organization can use Availity as a clearinghouse vendor by submitting your Medicaid EDI transactions with the payer ID 0002937.
  • Direct data entry claims can be submitted using Availity Essentials. You will also have the option to attach documentation with your initial claim submission.


Commercial:

  • All claim submissions are delivered to Availity. Availity will reject Medicaid membership claims if claims are received using the commercial EDI payer ID’s: 00834 and 00332.


Electronic remittance advice: Medicaid:

  • All 835 registrations must be sent to ODM.
  • If you use a clearinghouse or billing vendor, please work with them to ensure they are submitting your registrations to ODM.
  • You can view your digital 835s using Availity Essentials.


Commercial:

  • All 835 registrations are submitted and viewed on Availity Essentials.


Electronic claim status & eligibility Medicaid:

  • All EDI transactions including the EDI 275 attachment transaction, batch claim status & batch Eligibility request must be submitted to ODM.
  • If you use a clearinghouse or billing vendor, please work with them to ensure they are submitting transactions to ODM.
  • You can view claim status and eligibility using Availity Essentials.


Commercial:

  • All EDI transactions are submitted and viewed on Availity Essentials.


Attachments Medicaid:

  • The EDI 275 transaction for both unsolicited and solicited attachments must be sent to ODM.
  • To submit an attachment with your claim submission (unsolicited), you have the following options:
    • Submit your initial claim using the Direct Data Entry functionality on Availity Essentials. You will have the option to attach documentation while entering the claim.
    • Submit your claim and wait for the 835 and/or remittance advice containing the claim number. You can use the claim status feature to attach your document within Availity Essentials.
    • Please note, the option to upload an unsolicited attachment within Availity Essentials is not currently available; look for future enhancement communications.
  • If you are submitting an attachment due to a request from the payer (solicited), you can use the claim status feature to upload your documentation within Availity Essentials.


Commercial:

  • The EDI 275 transaction for both unsolicited and solicited attachments must be sent to Availity.
  • Attachments submitted with an 837 PWK segment can be uploaded using the Availity Essentials attachment tool by locating the notification in the inbox, or by uploading the attachment using the claim status feature with your claim number.


ODM contact information


*Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield.
OHBCBS-CD-015521-22


Featured In:
February 2023 Anthem Provider News - Ohio