FAQ: Electronic Data Interchange (EDI)
Registration
Is there something I have to load on my computer to use
the Submit EDI Claims application?
No, Submit EDI Claims is a browser-based application. You will only
need to launch your Internet browser and log on to the NIA provider
Web site using your secure login and password.
TIP: The Submit EDI Claims Application works best when using Internet Explorer (IE). If you use a browser other than IE, your results may be less than satisfactory. If IE is not already loaded on your computer, you can download it free of charge from the Web at http://www.microsoft.com/windows/ie/default.mspx. You can indicate IE to be your default browser or you can choose to use IE only when you access the NIA Web site.
What is "Submit EDI Claims"?
Submit EDI Claims is an online application that enables you to
exchange HIPAA formatted, standard transactions with NIA on the
secure NIA Web site.
What is the difference between Submit EDI Claims and
Submit a Claim Online?
Submit EDI Claims allows you to submit a batch of claims to NIA
using the required HIPAA file format. Submit a Claim Online allows
you to manually enter data in order to submit an individual
claim.
What do I need to do in order to use the Submit EDI
Claims application?
If you are interested in registering to Submit EDI Claims, please
request access to the application by sending an e-mail to EDISUPPORT@MagellanHealth.com.
How long will it take you to respond to my registration
request?
After you complete and submit your registration, it may take up to
two weeks for your request to be processed. NIA uses the
registration information that you provide to configure our systems
to accept files from you. During this time period you can check the
status of your registration online, but you will not be able to
submit or receive EDI files. Only after receipt of a registration
confirmation e-mail from NIA will you be able to submit and receive
EDI files.
Can I use both the Submit a Claim Online and the Submit
an EDI Claims applications for submitting claims to
NIA?
Yes. You can use both the Submit a Claim Online and the Submit EDI
Claims applications to submit claims to NIA electronically.
What if I currently submit files through a
clearinghouse? Can I still use the Submit EDI Claims
application?
You can continue to submit claims through your clearinghouse while
you are undergoing the registration process for submitting files
sent directly to NIA over the Internet. However, once you begin
submitting claim files directly to NIA through the Submit EDI
Claims application, you will need to discontinue sending NIA claims
through your clearinghouse. Submitting claims to both your
clearinghouse and through the NIA Submit EDI Claims application
could result in duplicate claims submission to NIA. Duplicate
claims will be denied by NIA.
When can I submit test files for
certification?
After your registration has been processed, you will receive a
confirmation e-mail from NIA that will include instructions on
submitting test files.
How long after submitting a test file will it be before
I can start submitting production files?
You will receive an e-mail from NIA when testing is complete and
you are able to send production files. You can also check the
status of each registered transaction within the Submit EDI Claims
application. Once you receive registration confirmation you'll find
a status summary at the top of each page, indicating the status of
each registered transaction. This summary also indicates whether
you can submit test or production files.
Where can I get a registration form?
To register for Submit EDI Claims, you must send an e-mail to EDISUPPORT@MagellanHealth.com
and request access to the
Submit EDI Claims application. Registration can only be accepted
over the Internet.
What if I make a mistake on the registration
form?
Changes to your registration form may be made any time after the
initial registration is submitted. However, the time for processing
your registration may be extended and may take up to two weeks from
the date the last change is submitted.
What if I need to change registration information after
I begin sending production files?
Changes to registration information may be submitted at any time
through the Submit EDI Claims application; however, most changes
will not take effect immediately. Changes to contact information
take effect almost immediately, but other change requests may take
up to two weeks to be processed. Until you receive confirmation
that the change has been made, all submitted files will need to use
the existing registration information.
How do I print my registration?
After you submit your registration, use the "Print" button at the
bottom of the Registration page to print a copy for your records.
You can also use your browser to print other pages in the
application, but these will not be as clean as the printer-friendly
copy available after your submission is completed.
Sending an EDI File to NIA over the Internet
Can I submit claims for any NIA member using the Submit
EDI Claims application?
Only claims for members for whom NIA is the claims payer can be
submitted through the Submit EDI Claims application. If NIA is not
the claim payer for a submitted claim, the claim will be rejected
and returned to you for submission to the appropriate claims
payer.
Can I submit claims for NIA employees through Submit EDI
Claims?
No. In order to protect their confidentiality, we ask that you not
submit claims electronically for services rendered to NIA
employees.
Is my file secure when I submit it through the Submit
EDI Claims or Submit a Claim Online applications?
Yes. Transmission of data through NIA's Web site is protected by
Secure Socket Layer (SSL) encryption, the same technology that
protects credit card transactions over the Web. This technology
scrambles data as it travels between your computer and ours, making
it virtually impossible for anyone to access your account
information.
What is PGP
Encryption?
PGP is a computer program that encrypts (scrambles) and decrypts
(unscrambles) data. To use PGP encryption, both the sender and the
receiver of the data will generate a private and a public key to
unscramble the data. The receiver of the data will send the public
key to the sender. The sender will encrypt the file using the
public key so that only the receiver with the private key can
unscramble the file.
How can I get PGP Encryption?
Information on cost and how to set up PGP encryption is available
at www.pgp.com. If you have
additional questions on PGP, please contact us at EDISUPPORT@Magellanhealth.com.
Do I have to use PGP Encryption to send
files?
NIA recommends that files be encrypted, even though transmission
over the Internet to our Web site is secure. NIA does not require
that you encrypt files that you send; however, if you choose not to
use PGP encryption, your response files will require the use of a
NIA-generated password to open.
Can I submit zipped files?
Yes, however it is not necessary to zip files before sending them.
If you choose to send zipped files, do not use password protection.
Files that have been password protected will be rejected and must
be resubmitted. Files that are sent from zipped directories cannot
be processed and will be rejected as well.
Can I submit multiple files with the same file
name?
No, NIA cannot accept the same file name for more than one file. If
you attempt to submit a file using a filename that has already been
used, you will receive an error message.
Will I receive confirmation that you have received my
file?
Yes. When you successfully send a file, you will receive immediate
online confirmation of receipt. A TA1 file will be returned for
every transaction that you send. A 997 and X12/HIPAA Status Report
will be returned if the TA1 is positive and 277U files may also be
returned.
How can I be sure NIA has received my
file?
After sending a file, you will receive a message informing you that
the file was sent successfully. If an error was encountered when
sending the file, an error message will appear.
What do I do if I receive a message telling me that my
file was not successfully sent?
If you encounter an error, we recommend that you attempt to resend
the file. If after two attempts the file cannot be sent and there
has been no alert indicating system maintenance is in process,
please contact NIA at EDISUPPORT@MagellanHealth.com.
How long will it take you to respond when I submit a
file online?
After you submit a claim file online, you will receive immediate
confirmation that your file has been received. It will take
approximately one business day for NIA to generate response files
that are available for electronic pickup.
How can I see what files I've already
sent?
The Send/Get EDI Claims tab displays a summary of all files
previously sent and received. You may search for your files from
this page, and you may also scroll through the file history.
Can I submit more than one file at a
time?
No, you can submit only one file at a time; however, you may submit
multiple files during one session. Simply select the Send File
button and select the file you want to send. After confirmation
that the file has been sent, repeat the steps to send additional
files.
Can I submit more than one claim per ST/SE
?
NIA's preferred standard is to submit one claim per ST/SE; however,
if it is necessary for you to submit more than one claim per ST/SE,
NIA can accommodate this request. For a definition of ST/SE and
other HIPAA terms, please refer to the Transaction Specific
Companion Guides.
What if I send the wrong file?
If you send the wrong file to production, please contact NIA at EDISUPPORT@MagellanHealth.com
immediately.
Receiving an EDI File from NIA
Do I have to use PGP Encryption to receive
files?
PGP is NIA's preferred method of encryption; however, NIA does not
require that you use PGP. If you choose not to use PGP encryption,
your response files will require the use of a NIA generated
password to open.
How will I get the NIA generated
password?
You will receive your password by e-mail. The NIA generated
password will be used to open all response files you receive from
NIA.
How will I be notified that a response file is
available?
You will need to check the Send/Get EDI Claims tab for your
response files that are awaiting pickup. Use the Get Files button
to select individual files for retrieval. You will not receive
automated notification that a response file is waiting for you.
How can I see what files I've already
received?
The Send/Get EDI Claims tab displays a summary of all files
previously sent and received. You may search your files from this
page, and you may also scroll through the file history.
What if I need to get another copy of a file that I have
previously received?
Send an e-mail to EDISUPPORT@MagellanHealth.com
to request another copy of
the file. When the copy is available, you will be notified by
e-mail. Return to the Send/Get EDI Claims page and the file that
you requested will be available for download.
Can I view an EOB online if I am receiving an HIPAA 835
Remittance Advice transaction?
Yes, you may view your EOB online through the Check Claims Status
application even if you are receiving the HIPAA 835 Remittance
Advice transaction.
Who can I contact with more questions?
For questions on the Submit EDI Claims application, or to report
technical problems, send an e-mail to EDISUPPORT@Magellanhealth.com.