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IMPORTANT: Are you enrolled in Medi-Cal? Has your contact information changed in the past two years? Give your county office your updated contact information so you can stay enrolled. Go to benefitscal.com or call the Los Angeles County Department of Public Social Services at 1-866-613-3777

Using Electronic Data Interchange (EDI)

Electronic Data Interchange (EDI) provides the ability to quickly and efficiently exchange healthcare information such as submitting claims, electronic remittance, eligibility, claims payment and other information in a safe, secure and cost effective way.  

Most importantly, successful electronic claims are loaded into L.A. Care’s adjudication system within one business day of receipt resulting in faster payment than paper submissions.
 

Advantages of using EDI

Several immediate advantages can be realized by exchanging documents electronically here are a few:

Ability to submit 24/7

L.A. Care accepts all claims electronically, including professional and institutional related submissions 24 hours a day, seven days a week.
 

Reduction of data entry and payment errors

Claims submitted electronically benefit from earlier detection of billing errors.  If your claim fails due to any pre-pass edit, the claim is returned back to your office for correction.  This editing reduces the likelihood of your claim being rejected or denied for payment once it enters the processing system.
 

Immediate verification of claims received

Receive immediate acknowledgement of claims received and confirmation through your clearinghouse within two days as to if claims have been accepted  or rejected.

In order to take advantage of EDI, you'll need to register with one of the following clearinghouses and  reference L.A. Care’s Payer ID “LACAR”.  

EDI COB Billing

Electronic COB submission utilizes automated remittance posting, ensures a consistent method of submitting COB claims while improving efficiency by eliminating the need to submit paper claims with the other payer’s Explanation of Benefits. You will need to understand L.A. Care’s COB submission requirements, and ensure your practice management system can accept claims with the required COB data format.

To take advantage of this functionality you will need to do the following:

  1. Review the COB Claims Companion Guide which contains the data mapping and format required for submission.
  2. Contact your Practice Management Software vendor to review the specifications in the Provider Guide and make any modifications needed.
  3. Begin submitting your COB claims electronically.

L.A. Care’s system is production-ready, and available to receive your COB claims immediately.  So please join us in our continuing efforts to improve our claims processing quality of service to our valued provider network.

Electronic Funds Transfer (EFT)

Electronic Funds Transfer (EFT) offers you a secure, efficient process for electronically depositing claims payment (including capitation and incentive payments, where applicable) into your designated bank account.  Taking advantage of EFT also means you can reduce administrative expenses while accessing online Electronic Remittance Advice (ERA) via a PDF formatted remittance advice, or through the HIPAA 835 transaction that can be used to auto-post into your accounts receivable without manual intervention.

Enrollment in Electronic Funds Transfer (EFT) – First Time Users

To enroll in EFT, you will first have to register with our business partner PaySpan Health.  If you are a first time user with PaySpan, you will need a registration code before you can complete the registration process.  You can request a registration code in one of the following 3 ways:

Once you have received your registration code, you can register by visiting www.payspanhealth.com and using your NPI, Tax ID and Billing ZIP Code.  The process will require you to:

  • Provide your personal information
  • Setup your banking information
  • Confirm your PaySpan account for electronic payments

If you need additional assistance, contact a PaySpan Health Provider Service Specialist by phone 1-877-431-2273 or email. 

Enrollment in Electronic Funds Transfer (EFT) – Existing PaySpan Users

If you have already registered with PaySpan Health, you may add L.A. Care as a new payer by following these simple steps:

  1. Login into your existing account at PaySpan
  2. Request a new registration code 
  3. PaySpan Health will send you an automated email with your new registration code
  4. Once you receive your registration code, go to www.payspanhealth.com
  5. Select “Your Payments”
  6. Select “Add New Reg Code”
    1. Enter the Registration Code
    2. Provider Identification Number
    3. Tax Identification Number
    4. National Provider Identifier
  7. Begin Registration

If you need additional assistance, contact a PaySpan Health Provider Service Specialist by phone 1-877-431-2273 or email. 

Additional Information You Need To Know

  • It is important to note that if you have multiple Provider ID’s, you will need to register all your provider Ids separately to ensure all your payments are sent electronically
  • EFT payments are typically deposited into your specified bank account within three business days following the claim date of process. This means that for any claims that complete processing day one (e.g. 3/1/17), an electronic remittance is available day two (3/2/17), and the electronic funds transfer will typically be deposited in your bank account on day three (3/3/17).
  • Electronic Funds Transfer checks have a different number sequence than your current paper checks
  • The daily electronic remittance file will be your office's notification of the payment that is posted to the account. Additional notification of checks and amounts received into the accounts should come from your bank. Contact your bank for their notification procedures.
Change Healthcare Benefits

To help better service our EDI Provider Network, and effective immediately, L.A. Care has contracted with Change Healthcare to become the exclusive clearinghouse for the submission of all your EDI claims.

Learn More
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Contact Us

Provider Claims and Eligibility:
1-866-522-2736 

Medical Management:
1-877-431-2273

Phone

Resources

Clean Claim Billing Requirements - CMS 1500
Clean Claim Billing Requirements - UB-04
New Payment Guidelines
COB Claims Companion Guide
NDC/UPN EDI Billing Requirements

Links to Visit

Change Health Care Clearinghouse