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Electronic Claims

What are Electronic Claims
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Electronic Claims

What are Electronic Claims?


EDI, an alternative to hard-copy invoice billing, is a method of inputting claims to HP, fiscal agent for Kentucky Medicaid. With electronic media, a provider or third party contractor can send Medicaid claims to HP via asynchronous telecommunication. (Modem to modem) The accounting system producing these claims files removes or corrects claims that have invalid information and claims that would cause problems in payment. All prescreening and key enter functions that manual billings undergo are performed by the provider or billing agency. EDI eliminates that time consuming clerical process of invoice preparation and handling and speeds the payment of claims. EDI, having been pre-edited for errors, have a much higher payment ratio than hard-copy claim submission.

All claim types, except claims requiring additional attachments can currently be billed using EDI.

Some editing is common to all claims, i.e., verification of dates. Each type of claim has unique specific edits.

Consistent with the requirements outlined in provider manuals, all claims received via EDI must satisfy the criteria listed in the manual for that type of claim.

Last Updated 5/15/2019 
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