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Filing Electronic Claims

Electronic Transaction Documents for UniCare Claims

 

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

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


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.


Electronic Remittance Advices (ERA) Registration

 

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).


Electronic Funds Transfers (EFT) Registration

 

To register or manage account changes for electronic funds transfers only, use EnrollHub, a CAQH Solution™ enrollment tool and secure 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 changes.

Important Notice About Receiving EFT Payments

If you were previously enrolled with Beacon Health Options for EFT, you will need to re-enroll for EFT with UniCare if you haven't already done so. If you don't re-enroll, you will automatically receive payment via check.

How to re-enroll for EFT with EnrollHub:

Questions? Call the CAQH Provider Help Desk at 844-815-9763 or email efthelp@enrollhub.caqh.org.


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:

  • Populate the claim with the frequency type code of 7 (adjustment) in Loop 2300 (CLM5-3).
  • Populate the Original Reference Number (ICN/DCN in Loop 2300 with the UniCare claim number).

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.

UniCare complies with HIPAA 5010 Transaction Standards and Code Sets, and with the electronic data interchange (EDI) standards for healthcare required by the Health Insurance Portability and Accountability Act (HIPAA). EDI is the computer-to-computer transfer of transactions and information. We encourage providers to submit claims electronically to improve productivity and efficiency.

UniCare 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.

For more information about UniCare electronic claims, call UniCare e-Solutions at 800-470-9630, Monday through Friday from 8 a.m. to 6 p.m. ET.