EDI resources

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Electronic Data Interchange (EDI)

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EDI Resources

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Carrier Code List
Companion Guides
Pharmacy Point-of-Sale Payer Sheet
Mailbox manuals
EDI policy
Other helpful links

This page provides the information current trading partners need to do business electronically with DHS. Make sure to eSubscribe to this page to find out whenever DHS posts new information to this page. You can also find out the most recent changes at this link.

NOTE: You will need Adobe Reader 6.0 or higher to view the guides and manuals listed below. If you do not already have this free software, you can download it now.

Carrier Code List

If your eligibility verification resource only lists a 4-digit code for the client's third-party resource, refer to the Insurance Carrier Code List (revised 10/08). This list provides the carrier name and contact information for each carrier code.

Companion Guides

These guides provide the payer-specific information that you need to complete transactions with DHS.

All current EDI submitters must make sure their transactions meet the payer-specific requirements in these guides and do business-to-business (B2B) testing with DHS.
These guides are a supplement to the X12 transaction implementation guides available on the Washington Publishing Web site.
All transactions with DHS must comply with National Provider Identifier (NPI) standards. For more information about NPI, go to this link.

Encounter Companion Guides	Version	Change Matrix
DHS 820 Capitation Payment - updated 6/12/08	v.3.3	9/9/08
DHS 834 COB PHP Contract Service Area Element Definitions Crosswalk - updated 1/5/09	v.2.1	N/A
DHS 834 Daily Enrollment File - updated 9/9/08	v.3.4	9/9/08
DHS 834 HD04 Element Definitions - updated 9/9/08	v.3.4	9/9/08
DHS 834 Language Code Crosswalk - updated 11/7/08	v.1.6	N/A
DHS 834 Race Code Crosswalk - updated 11/17/08	v.1.2	N/A
DHS 834 Maintenance Reason Code Crosswalk - updated 6/12/08	v.3.3	N/A
DHS 834 Monthly Enrollment File - updated 9/9/08	v.3.4	9/9/08
DHS 835 Payment/Advice Companion Guide - updated 9/9/08	v.3.1	9/9/08
DHS 837 Dental - 4010A1 - updated 5/16/08	v.3.0	9/9/08
DHS 837 Institutional - 4010A1 - updated 5/16/08	v.3.0	9/9/08
DHS 837 Professional - 4010A1 - updated 5/16/08	v.3.0	9/9/08
DHS NCPDP Companion Guide - updated 5/20/08	v.3.0	9/9/08
MCO Status File - updated 7/14/08	N/A	N/A
Fee-for-service Companion Guides	Version	Change Matrix
DHS 835 Payment/Advice Companion Guide - updated 5/21/08	v.3.0	9/9/08
DHS 837 Institutional - 4010A1 - updated 5/21/08	v.3.0	9/9/08
DHS 837 Dental - 4010A - updated 5/21/08	v.3.0	9/9/08
DHS 837 Professional - 4010A1 - updated 9/9/08	v.3.2	9/9/08
Combined (Encounter/FFS) Companion Guides	Version	Change Matrix
DHS 270 Eligibility Benefit Inquiry - updated 6/12/08. There have been no changes since this guide was last available.	v.3.3	6/12/08
DHS 271 Eligibility Benefit Response - updated 12/12/08	v.3.4	12/12/08
DHS 276 Claim Status Request - updated 6/12/08	v.3.3	6/12/08
DHS 277 Claim Status Response - updated 6/12/08	v.3.3	6/12/08

Pharmacy Point-of-Sale (POS) Payer Sheet

The POS Payer Sheet (PDF - version 2.0 revised 11/28/08) provides the payer-specific information that you need to complete pharmacy Point-of-Sale (POS) transactions with DHS. Important changes are highlighted in yellow; mandatory changes in red. The Payer Sheet Change Matrix (PDF - version 1.5 revised 11/28/08) also highlights these changes.

All pharmacies must make sure their POS transactions meet the payer-specific requirements in these guides and do business-to-business (B2B) testing with DHS.
These guides are a supplement to the Telecom Standard Version 5.1 Payer Templates available on National Council of Prescription Drug Programs (NCPDP) Web site.
All transactions with DHS must comply with National Provider Identifier (NPI) standards. For more information about NPI, go to this link.
Effective with the with replacement MMIS, DHS now requires the client's/recipient's date of birth (DOB) in the Patient Segment, field 304-C4, for all B1 and B3 POS transactions. See page 2 of the Payer Sheet for more information.

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Manuals

Title	Version	Eff. Date
Mailbox Access Instructional Manual	v1.53	02/06/2007
Mailbox Access and Pharmacy Data Guide	v2.6	03/25/2005
Mailbox Access and B2B Testing Manual	v2.7	02/06/2007
Mailbox Access and B2B Testing Manual for Managed Care Plans	v2.7	02/06/2007

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EDI policy

The EDI Administrative Rules establish the DHS registration process and requirements applicable to individuals or entities that desire to be treated as Trading Partners or EDI submitters with DHS. They also govern the conduct and requirements for all EDI transactions with DHS.

EDI rules are now part of DHS Department-Wide Support Services (DWSS) rules (Chapter 407, Division 120, "Electronic Data Transmission"), posted on the DWSS Web site.
To eSubscribe to get automatic e-mail updates when DWSS adopted rules are updated, click here. You can also view the most recent updates at this link.

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