What are Payer Id Codes?
Before you can exchange EDI transactions with a trading partner, you need to know what Payer ID Codes are. Payer ID Codes, also known as Receiver Codes, are the primary identifier used to route your EDI transaction to the appropriate entity.
In the Health Care world, these codes are associated with which insurance/payer/carrier (i.e. Aetna, Cigna, NE MDCR, PA BCBS, etc...) that the transaction is for. This is how the EDI system is able to ensure your transaction is routed to the correct payer.
These codes are typically 5 characters in length and often differ, depending on the entity (i.e. Clearinghouse or Vendor). It's important to reference the correct payer id list that correlates to the entity you send claims through.
Eclaims provides a payer id code list that is tailored specifically for those who send EDI transactions directly to the payer. If you're not sending transactions directly to the payer (i.e. sending through Clearinghouse and/or Vendor), you should reference the companion guide of the trading partner you're sending transactions through.
Once you've located the correct payer id code, you will need to enter that code into your software for each carrier. Your software will most likely have a specific field for you to enter the payer id code. Look for where you enter insurance/payer information.
Here are some of the possible locations of where the payer id code might be populated, specifically for claims transactions.
HCFA (CMS 1500) Claim Form
- 62308 CIGNA
- PO BOX 182223
- CHATTANOOGA, TN 37422-7223
ANSI X12 837 - Professional/Institutional Claim
- Payer Name Loop (2010BB) - NM109 - Payer Identifier
Find additional information on the 2010BB Payer Name Loop specifications.