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Electronic Data Interchange (EDI) Support

ATTENTION: Trading partners are reminded to use the MOVEit/Secure File Transfer Protocol (SFTP) to submit all X12 files such as 837 claim files and 270 eligibility requests. Visit the MOVEit web page to log into the SFTP server.   

EDI News and Updates

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 Update Electronic Remittance Advice (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 Provider Web Portal. In this example, Dr. Doolittle does not need a TPID.
  • Example 4: In addition to submitting single claims through the Provider 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 Web Portal Registration Quick Guide 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 Electronic Remittance Advice (ERA) Quick Guide located 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.