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- Antidepressant Medication
- Baby Partners
- CAHPS Resources
- Care Guidelines
- Developmental Screenings and Surveillance
- Diabetes Prevention Programs
- Disease and Medication Management
- EPSDT / Bright Futures
- ICD-10 Coding and Risk Adjustment
- Lead Screening
- Medication Management and Adherence
- Member Rewards
- Oral Health Resources
- Patient Management
- Patient Safety Reporting
- Quality and Population Health
- Smoking Cessation
- TiPS: Telephonic Psychiatric Consultation Service Program
- Opioid Use Resources
I do not currently submit claims electronically. How do I begin?
Contact SDS directly. All trading agreements would come through them exclusively. You can contact them directly at stream.support@sdata.us.
What if my billing software vendor uses another clearinghouse such as NDC, Med-E America, ETS, Equifax, etc.?
Please contact your billing software vendor for details.
Once I am set up to send claims electronically, how many claims should I initially send?
We recommend that you start by sending 20-30 claims to ensure no issues exist. We also suggest that you contact the EDI Support line at EDI@jeffersonhealthplans.com after submitting the first batch of claims so that we can analyze them for any potential issues.
Why can't I just use email to submit my claims electronically?
Email is very different from EDI. The EDI data is transmitted in a structured format, based on the use of transaction standards, which ensures that all participants use a common language.
Are reports created for providers that identify claim rejections/errors?
Yes, there are two types of reports available to providers:
- RPT01/RPT05: This report identifies all claim rejections with invalid and/or missing data that have been sent back to the provider from SDS. Claims rejected at this level cannot be identified by us and are rejected before reaching our claims processing system. To inquire about claim errors found on this report, please contact your billing software vendor.
- RPT10/RPT11: This report identifies all claim rejections with invalid and/or missing data that have been sent back to the provider from us. To inquire about claim errors found on this report, please contact the EDI Support Line and provide the Carrier Reference Number (Car Ref #) of the error(s) in question to the representative.
What information do I need to submit my claims electronically to you?
Payor ID. The following payor IDs are required on claims sent electronically for our members:
- Medicare PPO: RP099
- New Jersey Medicare PPO: NJ099
- ALL other products (Medicaid, CHIP, Medicare HMO/DSNP, Individual and Family): 80142
National Provider Identifier (NPI). Failure to include this information will result in rejection of the claim.
What is my NPI number?
An NPI is assigned to the provider by the Centers of Medicare and Medicaid Services (CMS). It is a valid 10-digit numeric value based on rules supplied by CMS.
What if I do not have a computer to submit claims electronically?
If you do not have the appropriate equipment for the electronic claims process, we suggest that you contact Smart Data Solutions (SDS) at stream.support@sdata.us or your billing software vendor for more information.