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Electronic Data Interchange (EDI)

What is EDI?

Electronic data interchange (EDI) is the exchange of business transactions in a standardized format from one computer to another. Health Net providers use this technology to communicate claims, electronic remittance, claims payment, eligibility, and other information, providing a paperless and efficient process.

Quicker claims payment, confirmation reports, and elimination of paper and associated expenses are just a few of the reasons why nearly 80 percent of Health Net's claims are submitted electronically. EDI also gives you the tools you need to track electronic claims status, improve timely filing, and access daily accept/reject reports. This also means easier receivables and account reconciliation. By using Health Net-approved vendors and clearinghouses, HIPAA compliance is done for you, and you'll have automatic access to highly secure and time-tested solutions.

Health Net has the following transactions available for providers through one of our approved clearinghouses: 837 electronic claim submission, 835 electronic remittance advice, and EFT payments. We are CORE Phase III certified with our real-time claims status and member eligibility transactions as well as compliant with the federal operating rules.