EDI Support

Durable Medical Equipment (DME) Claims Rejecting for Invalid Health Maintenance Organization (HMO): Some DME claims are unable to be submitted and rejected with code 41 “Submit to other processor or primary payer HMO coverage exists.” Pharmacies are advised to contact their third-party switch vendors. Colorado Community Health Alliance is a primary care provider not a third-party liability insurance. Please continue to provide emergency 72-hour refills of emergent medications for Health First Colorado members. Third-party switch vendors that provide the eligibility results should contact DXC at 1-844-235-2387, option 2, then option 3, for “EDI” (Electronic Data Interchange) for assistance with the eligibility response.

72-hour emergency supplies for medications covered under the pharmacy benefit may be available. The pharmacy may call Magellan (1-800-424-5725) to request this override. This is not available for DME supplies, which are processed through DXC.

New Enrollment

In order to submit batch claims or batch eligibility files, or in order to receive batch files (such as the 835) to the Colorado interChange system, submitters must enroll as a Trading Partner for the Colorado interChange and pass test transactions for HIPAA compliance.

Only one Trading Partner application needs to be completed per Trading Partner, even if the Trading Partner submits for multiple providers. Accurate and timely completion of the profile form will prevent delays in testing and approval for production processing.

A Trading Partner ID (TPID) is ONLY needed to receive EDI information from or transmit EDI information to the Colorado interChange, and ONLY the submitter or receiver needs the TPID. Submitters of interactive (single) claims through the Provider Web Portal do not need a TPID anymore (unless to receive an 835). If a TPID is not needed, it is not necessary to enroll as a Trading Partner.

Example 1: Clearinghouse XYZ submits batch claims for Dr. Jones. In this example, Clearinghouse XYZ needs a TPID; Dr. Jones does not.
Example 2: Dr. Pepper submits his own batch claims using software from a vendor. In this example, Dr. Pepper needs a TPID.
Example 3: Dr. Doolittle submits her own interactive (single) claims through the provider Web Portal. In this example, Dr. Doolittle does not need a TPID.
Example 4: In addition to submitting single claims through the Web Portal, Dr. Doolittle also has Clearinghouse XYZ submit batch claims for her. Clearinghouse XYZ needs a TPID (they can use the same TPID from example 1). Dr. Doolittle still does not need a TPID.

Step 1:
Download and review the Getting Started Guide for enrollment instructions.

Step 2:
Complete Trading Partner enrollment.

Step 3:
Download the Testing Packet, complete the testing process and receive approval to submit production transactions.

Step 4:
Register for the Provider Web Portal as a "Billing Agent" and assign a Trading Partner Administrator.

Step 5:
After receiving approval for production transactions, send the TPID to the providers who will be submitted for. Refer to these suggested instructions for providers. The Department recommends that submitters download and customize these instructions prior to sending them to providers.  

Step 6:
Providers add you as a Registered Billing Agent/Clearinghouse/Switch Vendor (see instructions in step 5).

Step 7:
Submit production batch claims on or after March 1, 2017.

Update to Billing Provider ID Requirements on Batch Submissions

Previously, if a submitter used identical information in Loop 2310C N3 and N4 and Loop 2010AA N3 and N4 for the billing provider information, the file would not receive a compliance error. As of May 18, 2018, this has been corrected to comply with the X12 standards and users will receive an error if the two fields have identical information. Contact EDI services at 1-844-235-2387, option 3 for more information.

Need Assistance? 

The EDI Help Desk is available through the Provider Services Call Center (1-844-235-2387). 

Companion Guides and Instructions
Communications to Submitters