Electronic data interchange (EDI) is the automated transfer of data in a specific format following specific data content rules between a health care provider and Medicaid, or between Medicaid and another health care plan.
- For billing, EDI speeds payment and eliminates costs associated with paper claims.
- You can submit electronic claims through a clearinghouse or through your existing, HIPAA-compliant business management software.
This information is for health care providers, clearinghouses and billing services that submit transactions to or receive transactions from Medicaid.
Testing Requirement and Instructions
To use EDI, a provider or clearinghouse must first test transmissions on the Maryland Medicaid Electronic Exchange (MMEE).
Enroll in Testing
- Email [email protected] and include your company name, contact information and the type of EDI transaction you intend to submit. Include “Enrollment for HIPAA 5010 testing" in the email subject line.
- You will receive the 005010 TP EDI Enrollment Form, Submitter Identification Form and the Trading Partner Agreement. Email all completed and signed forms to [email protected].
- Upon receipt of the completed forms, MDH will enroll you for testing. You will receive a login, password, URL and connectivity instructions for the Maryland Medicaid Electronic Exchange (MMEE) web portal.
Medicaid Submitter Enrollment and Agreement
HIPAA EDI Transactions: Get Your Companion Guides Here
Medicaid Companion Guides for 005010
Resources
Contact
For more information or questions about Medicaid electronic billing and EDI transactions, see contact by topic EDI, electronic billing.
