EDI Transaction Overview

GENERAL OVERVIEW

All Optima Health Companion Guides are to be used with the HIPAA-AS Implementation Guide.  The HIPAA Implementation guides provide comprehensive information needed to create each ANSI transaction set.  The Optima Health Companion Guide is used in conjunction with the HIPAA Implementation Guide; it is intended to clarify issues where the HIPAA Implementation Guide provides options or choices to be made.  Download the HIPAA Implementation Guide from: http://www.wpc-edi.com/hipaa/HIPAA_40.asp

BUSINESS USE

  • Each EDI vendor will have to sign a Trading Partner Agreement.
  • Each transaction set will be used to expedite the execution of electronic information pertaining to a health encounter.
  • To accelerate the processing and payment of a claim or encounter. The 837 transaction may be sent daily with a disposition report available the next business day.  The disposition report replaces the 997 Acknowledgement File.
  • The 835 transaction will contain Remittance Information as well as Electronic Funds Transfer (EFT).  We can not separate the two.
  • The 835 will be transferred on a calendar basis.  Vendors will receive a calendar monthly stating when their 835 information will be available.
  • Vendors may elect to receive EFT/ERA from Optima Health directly, as long as they can receive data files in the HIPAA compliant ANSI 835 format.
CONNECTING WITH OPTIMA HEALTH
Optima Health uses the Microsoft Internet Explorer browser and the WS_FTP Windows based FTP application for transferring files.

Using the Microsoft Internet Explorer browser

To use Microsoft Internet Explorer to access Optima Health's Web FTP server, enter https://webftp.sentara.com/ in the address line.  With this option, vendors will be responsible for the file transfers to and from their assigned folder(s).  If a vendor uses this option, the vendor will be given a login ID and password.  The Web URL is self-explanatory, follow the directions on the URL after you login the Web FTP server.

Upload file from PC to server

  • Login URL https://webftp.sentara.com
  • At “File Upload” section,  click “Browse”
  • Locate and select the file from your local computer
  • Click file name box for new or same file name on server
  • Provide your partner with the share user login information above

Download file from server to PC

  • At “File Download” section, right click on the file name.
  • Select “Save Target As”
  • Locate folder and save into your PC
Using WS_FTP
Vendors who allow clients to access their FTP server can select this option.  With this option, the vendor’s FTP server will have to be FTP enabled with port 22 open.  Optima Health will be responsible for file transfers to and from the vendor’s FTP server.
 
To set up this option, Optima Health will need the vendor’s IP address or host name, login ID and password (provided by vendor), and access to the directory folders where the to and from file transfers will occur.

 
Electronic Transaction Questions
Please Contact Us.
 
TESTING
 
Once a Trading Partner Agreement is signed and the method of transferring files determined, test files may be submitted to Optima Health. 

  • Inbound transaction will be tested with Claredi to ensure transactions are valid and compliant.
  • 837 claims must have valid Optima Health member ID numbers and Optima Health provider ID numbers.
  • Optima Health will work will all trading partners to identify and eliminate errors.
  • The Electronic Funds Transfer/Electronic Remittance Advice implementation timeline is dependent on the trading partners ability to test the receipt and distribution of the EFT/ERA data files. 
  • Testing is expected to take no more than 2 months to complete.
  • Optima Health will notify trading partner that transaction testing is complete and schedule a mutually agreed upon date to move the transaction to production.

Quick Links:

Forms
EDI Setup form - Providers (PDF)
 
Companion Guides