Electronic Data Interchange (EDI) Support

ATTENTION:  Trading partners will be able to access MOVEit/Secure File Transfer Protocol (SFTP) system on Sunday, May 19, 2024, from 4:00 p.m. to 8:00 p.m. MT to send files. A response will not be received from the systems during this window.

 ATTENTION: Submitters may now see Universal Aid Code “MH” associated with some Waiver Benefit Plans for eligible members. Beginning March 1, 2024, the new MH Universal Aid Code replaces thirteen (13) prior aid codes. The MH Universal Aid Code will appear in the 834 Benefit Enrollment and Maintenance Transaction, 2000 REF02 segment, where REF01 is “17.”  It will also be shown in the 2110C EB05 segment of the 271 Health Care Eligibility Benefit Response, located at the end of the plan coverage description. Waiver Benefit Plans for eligible members may be missing from a member Benefits Details list due to a known delay by the counties in determining the benefit plans.

ATTENTION: Gainwell Technologies and Health First Colorado (Colorado’s Medicaid Program) are aware of a cyber security issue that involved Optum Change Healthcare (CHC). The issue did not impact Gainwell Technologies’ network or systems. Claims submitted for processing through the CHC Relay Health EDI are being received.

Communications to Submitters

New Enrollment

To submit or receive batch files (such as claims or eligibility), submitters must enroll as a trading partner and pass test transactions for Health Insurance Portability and Accountability Act (HIPAA) compliance.

Only one trading partner application needs to be completed per trading partner, even if the trading partner submits for multiple providers. Accurate and timely completion of the profile form will prevent delays in testing and approval for production processing.

A Trading Partner ID (TPID) is only needed to receive EDI information from or transmit to the Secure File Transfer Protocol (SFTP), and only the submitter or receiver needs the TPID. 

Providers who submit interactive (single) claims through the Provider Web Portal do not need a TPID.

Providers do not need to enroll for a trading partner ID, only the batch submitter. Providers do not need to complete any EDI enrollment information unless they wish to designate the X12N ERA 835 to their submitter. Refer to the Updating an ERA quick guide for more information.

  • Example 1: Clearinghouse XYZ submits batch claims for Dr. Jones. In this example, Clearinghouse XYZ needs a TPID; Dr. Jones does not.
  • Example 2: Clearinghouse XYZ now wants to also submit for ABC Health Clinic. ABC Health Clinic does not need a TPID. Since Clearinghouse XYZ is already enrolled, it does not need to get another TPID.
  • Example 3: Dr. Doolittle submits her interactive (single) claims through the Web Portal. In this example, Dr. Doolittle does not need a TPID.
  • Example 4: In addition to submitting single claims through the Web Portal, Dr. Doolittle also has Clearinghouse XYZ submit batch claims for her. Clearinghouse XYZ needs a TPID (they can use the same TPID from example 1). Dr. Doolittle still does not need a TPID.

Step 1:
Download and review the Getting Started Guide listed below in the Companion Guides and Instructions section for enrollment instructions.

Step 2:
Visit the Provider Web Portal and click Trading Partner in the bottom left corner to complete the Trading Partner Enrollment application.

Step 3:
Download the Trading Partner Testing Packet listed below in the Companion Guides and Instructions section to complete the testing process to receive approval to submit production transactions.

Step 4:
Register for the Provider Web Portal as a Billing Agent and assign a trading partner administrator. Refer to the Provider Web Portal Quick Guide - Web Portal Registration on the Quick Guides web page.

Step 5:
Send the TPID to the providers for whom you will be submitting after receiving approval for production transactions. Refer to the Updating an ERA X12 835 Information - Provider Web Portal Quick Guide available on the Quick Guides web page. Submitters can refer providers to this resource.

Step 6:
Providers add you as a Registered Billing Agent/Clearinghouse/Switch Vendor. Refer to the Instructions for Adding Trading Partner ID (TPID) Authorization listed below in the Companion Guides and Instructions section.

Step 7:
Submit production batch claims.

Need Assistance?

Contact the Provider Services Call Center with any questions.

Companion Guides and Instructions

Behavioral Health Administration (BHA) Documents

The following companion guide is only for use if the payer is Behavioral Health Administration (BHA). BHA is a state-funded program that is not part of Health First Colorado (Colorado’s Medicaid program) or Child Health Plan Plus (CHP+). BHA is a separate entity that is addressing behavioral health needs of individuals not covered by other medical assistance programs.