Electronic Transactions and Claim Payer IDs

Submit claims using a clearinghouse or to LifeWise directly

We currently partner with many EDI clearinghouses and vendors and often add news ones as requested. A clearinghouse acts as a go-between for the provider and the payer (health plan). Using a clearinghouse means you can reach multiple payers through a single vendor. Check with your clearinghouse for capability details on how to send claims to LifeWise. You can also submit your claims directly to us. Please email us for details.

Before you enroll, you'll need to check with your system vendor or clearinghouse to confirm that your system can send claims in the HIPAA-required format. Once you've confirmed that your system is good to go, you can enroll by completing an EDI trading partner enrollment form. Please email us or call 800-435-2715  and we'll send you the form. If you're using a clearinghouse, be sure to contact them first about how to send claims to LifeWise.

How will I know if my electronic claim was accepted or rejected?
We create an accept/reject report that we share with our direct submitters and clearinghouses. Check with your clearinghouse about receiving reports.

Make sure your National Provider Identifier (NPI) is noted on your electronic claims.

LifeWise also offers the following HIPAA transactions.

• 270/271—Health Care Eligibility Benefit Inquiry and Response
• 276/277—Health Care Claims Status Request and Response
• 835—Health Care Claim Payment/ Remittance Advice
• 837—Health Care Claim: Professional, Institutional, Dental
• 999—Functional Acknowledgements

Please contact us for details on exchanging specific transactions other than claims.

You can submit a corrected, replacement, or voided claim electronically using the HIPAA 837 standard claims transaction. Please include the following information:

• Frequency code of '7' in loop 2300, CLM05-3 segment to indicate a corrected/replacement of a previously processed claim. Use '8' to void a claim you billed in error.
• The initial LifeWise claim number (in loop 2300, REF01 must contain 'F8' and REF02 must contain the claim number).
• A free-form note (highly recommended) with an explanation for the corrected/replacement claim, in loop 2300 claim note as:
  • For professional and dental claims, segment NTE01 must contain 'ADD' and segment NTE02 must contain the note, for example: NTE*ADD*CORRECTED PROCEDURE CODE
  • For institutional claims, segment NTE01 must contain 'UPI' and segment NTE02 must contain the note, for example: NTE*UPI*CORRECTED LAB CHARGES

Secondary claims via EDI

When sending us a secondary claim, please include the following required information:

• Primary payer name
• Primary payer member ID for the patient
• Primary payer allowed amount
• Primary payer payment amount
• Primary payer reason for nonpayment (i.e., non-covered service, deductible, benefit maximum)
• Primary payer adjudication date for claim is required

If you have questions about billing these from your system, please contact your system vendor or clearinghouse.

Medicare note: When LifeWise is secondary to Medicare, there's no need to submit claims to LifeWise if your Medicare explanation of payment indicates the claim was forwarded (or crossed over) to the secondary payer. Submitting the claim to us will cause a duplicate.

Electronic Funds Transfer (EFT) - Sign up for convenient, faster payments.

National Uniform Claim Committee (NUCC) - Learn about mapping from the 1500 claim form to 837.

National Uniform Billing Committee (NUBC) - Get additional institutional claim information.

OneHealthPort - View best practices for electronic transactions.

Email: EDI@LifeWiseHealth.com
Phone: 800-435-2715
Fax: 425-918-4234 (for EDI enrollment forms only)

Mailing Address:
7001 220th Street SW
Mountlake Terrace, WA 98043-2124

If you need to submit paper claims, correspondence, or medical records, please mail to:
LifeWise Health Plan of Oregon
P.O. Box 91059
Seattle WA 98111-9159