HIPAA transactions

We support all HIPAA-compliant electronic transactions. As a component of The Health Insurance Portability and Accountability Act (HIPAA), it is required that all medical records, billing and patient accounts meet consistent documentation, handling and privacy standards.

Payer ID 39113

If you are interested in submitting Electronic Data Interchange (EDI) transactions for member eligibility, claim submission, claim acknowledgement, and/or claim status, download and complete our EDI Setup Form (PDF). Complete the EDI setup form by filling it out electronically and saving the file. Once completed, send the PDF as an attachment in an email to edi@prevea360.com.

EDI setup form 39113 (PDF)

EDI Transaction Type
EDI Transaction Number
Connection Setup
Alternative to EDI
Eligibility Inquiry and Response
270/271
Real-time connection available through our Clearinghouse Smart Data Solutions.
Benefit Eligibility can be confirmed real-time through our Provider Portal.
Claim Submission
837Claim Submission and Acknowledgement responses through our Clearinghouse Smart Data Solutions.
We have partnered with Smart Data Solutions to offer claim submissions by manually keying in the claim information and submitting them electronically through the Smart Data Stream Clearinghouse Portal. There is no cost for providers or trading partners who submit claims using this portal. Rejected claims can also be corrected and resubmitted through this portal. Register by contacting Smart Data Solutions at 1-855-297-4436 or online through the Account Creation Page for Payer Enrollments webpage.
Claim Acknowledgement
277CA
Claim Submission and Acknowledgement responses through our Clearinghouse Smart Data Solutions.
Claim Acknowledgment (for if claims were accepted or rejected for adjudication) can be confirmed through our Confirmation Reports Portal.
Claims Status Inquiry and Response
276/277
Real-time connection available through our Clearinghouse Smart Data Solutions.
Claim status can be confirmed real-time through our Provider Portal.
Payment/Advice (exclamation of payment)
835
We have partnered with Change Healthcare for the exchange of both paper explanation of payments and checks as well as electronic remittance advices and electronic funds transfers. Please visit Change Healthcare's Payer Enrollment Services webpage.
A provider can view and download a copy of the Explanation of Payment by Claim ID through our Provider Portal.

Scheduled downtime

Weekly:

  • 7  to 11 p.m. Thursday – Our plan weekly changes. This may result in intermittent outages for real-time transactions.

First weekend of every month:

  • 8 p.m. Sunday to midnight Monday - Our plan systems maintenance. This can result in intermittent outages for all real-time transactions.


Third weekend of every month:

  • 8 p.m. Saturday to 2 a.m. Sunday – Vendor monthly systems maintenance. This can result in intermittent outages for all real-time transactions.
  • 6 p.m. Sunday to midnight Monday - Our plan systems maintenance. This will affect all real-time transactions.


Contact us

If you have any questions, contact the EDI Support Team for Payer ID 39113 at edi@prevea360.com.

Payer ID 41822

Availity is the EDI clearinghouse for HIPAA transactions under payer ID 41822. Go to the Availity EDI Gateway for EDI setup.

More HIPAA information