Electronic transactions

Sending electronic data interchange (EDI) transactions can help claims process faster and improve your cash flow.

LifeWise supports the exchange of all transactions mandated by the Health Insurance Portability and Accountability Act (HIPAA). LifeWise can exchange transactions with you directly or through a billing service or clearinghouse.

Claim Payer IDs

Claim payer IDs are used to make sure your electronic transaction is routed to the right health plan. If you're using a clearinghouse, be sure to verify all payer IDs as they might request that you use a different payer ID than those listed here.

Claim payer IDs by category for LifeWise

Plan: LifeWise Health Plan of Washington*
Professional: 00430 or 91049
Institutional: 00430 or 91049
Dental: 47570

Getting started

Submit claims using a clearinghouse or to LifeWise directly

We currently partner with many EDI clearinghouses and vendors and often add news ones as requested. A clearinghouse acts as a go-between for the provider and the payer (health plan). Using a clearinghouse means you can reach multiple payers through a single vendor. Check with your clearinghouse for capability details on how to send claims to LifeWise. You can also submit your claims directly to us. Please email us for details.

Before you enroll, you'll need to check with your system clearinghouse or vendor to confirm that your system can send in the HIPAA-required format. Once you've confirmed that your system is good to go, you can enroll by completing an EDI trading partner enrollment form. Please email us or call 800-435-2715 and we'll send you the form. If you're using a clearinghouse, be sure to contact them first about how to send claims to LifeWise.

How will I know if my electronic claim was accepted or rejected?
We create an accept/reject report that we share with our direct submitters and clearinghouses. Check with your clearinghouse about receiving reports.

Make sure your National Provider Identifier (NPI) is noted on your electronic claims.

HIPAA transactions

LifeWise also offers the following HIPAA transactions.

• 270/271—Health Care Eligibility Benefit Inquiry and Response
• 276/277—Health Care Claims Status Request and Response
• 835—Health Care Claim Payment/ Remittance Advice (see EFT information with InstaMed below under Resources)
• 837—Health Care Claim: Professional, Institutional, Dental
• 999—Functional Acknowledgements

Please contact us for details on exchanging specific transactions other than claims.

Corrected, replacement, voided, and secondary claims

You can submit a corrected, replacement, or voided claim electronically using the HIPAA 837 standard claims transaction. Please include the following information:

• Frequency code of '7' in loop 2300, CLM05-3 segment to indicate a corrected/replacement of a previously processed claim. Use '8' to void a claim you billed in error.
• The initial LifeWise claim number (in loop 2300, REF01 must contain 'F8' and REF02 must contain the claim number).
• A free-form note (highly recommended) with an explanation for the corrected/replacement claim, in loop 2300 claim note as:
  • For professional and dental claims, segment NTE01 must contain 'ADD' and segment NTE02 must contain the note, for example: NTE*ADD*CORRECTED PROCEDURE CODE
  • For institutional claims, segment NTE01 must contain 'UPI' and segment NTE02 must contain the note, for example: NTE*UPI*CORRECTED LAB CHARGES

Secondary claims via EDI

When sending us a secondary claim, please include the following required information:

• Primary payer name
• Primary payer member ID for the patient
• Primary payer allowed amount
• Primary payer payment amount
• Primary payer reason for nonpayment (i.e., non-covered service, deductible, benefit maximum)
• Primary payer adjudication date for claim is required

If you have questions about billing these from your system, please contact your system vendor or clearinghouse.

Medicare note: When LifeWise is secondary to Medicare, there's no need to submit claims to LifeWise if your Medicare explanation of payment indicates the claim was forwarded (or crossed over) to the secondary payer. Submitting the claim to us will cause a duplicate.

Resources

Instamed delivers all EFT and ERA (835 payments) for LifeWise Individual plans. Visit our electronic funds transfer page for sign up and payment information.

National Uniform Claim Committee (NUCC)—Learn about mapping from the 1500 claim form to 837.

National Uniform Billing Committee (NUBC)— Get additional institutional claim information.

OneHealthPort—View best practices for electronic transactions.

Contact us

Email: EDI@LifeWiseHealth.com

Phone: 800-435-2715

Fax: 425-918-4234 (for EDI enrollment forms only)

Mailing Address:
7001 220th Street SW
Mountlake Terrace, WA 98043-2124

Submit paper claims , correspondence, or medical records to:
LifeWise Health Plan of Washington
P.O. Box 21552
Eagan, MN 55121