EDI frequently asked questions

What is your Payer ID for Providence Preferred?

Check your clearinghouse's website for their Payer ID list. Providence Preferred and Providence Health Plan have separate Payer IDs. If the Payer ID list is not available on the website, call Deb Wallenstein with Providence Health Plans at 503-574-7450 or e-mail her at Debra.Wallenstein@providence.org

Back to Top

My claim file was rejected at the clearinghouse.

Make sure the Payer ID is for Providence Preferred PPO and not Providence Health Plan. Some edits are different for PPO and will cause the files to reject.
One of the most common reason claims are rejected is because the provider is not submitting their claims with the 10 digit NPI. There is an EDI hard coded edit that will only take a ten digit electronic provider number.

Back to Top

Are you sending the tax ID number in the NPI field?

The tax ID should be in box 25 and the provider number in box 33 pin# on the HCFA-1500 form. If you cannot determine why the claim was rejected please contact Deb Wallenstein.

Back to Top

I'm sending my claims to the clearinghouse, but Providence PPO is getting paper claims.

Check with the clearinghouse to see if they have you set up for PPO electronic claims. Sometimes there is an enrollment process that needs to be completed with the clearinghouse before they submit your claims electronically.

Back to Top

What is my Provider Number for Electronic Claims?

Providers can use their individual provider NPIs effective April 10, 2007. The provider number is the same as the Providence Health Plan provider number for electronic claims.
If the above listed reasons are not the problem for electronic claims, the provider should call their clearinghouse and open a trouble ticket. Most issues can be resolved between the clearinghouse and the provider.
If the provider is still getting rejected claims, have the provider call Deb Wallenstein with Providence Health Plans at 503-574-7450 or e-mail her at Debra.Wallenstein@providence.org

Back to Top