• Washington and Oregon Medicare Part B Electronic Claims Submission Specifications
• HIPAA insurance claims format requirements

Washington and Oregon Medicare Part B Electronic Claims Submission Specifications

In order to submit Washington and Oregon Medicare Part B claims electronically to Availity, LLC, enrollment with Noridian is required. Please call Noridian Government Services EDI Support Services at (866) 849-7243 who will assign a Submitter ID. You must also complete an EDI Registration Form and CMS EDI Enrollment Form which are available at the Noridian Web site. Both forms should be printed, completed in full, then faxed to Noridian EDI Support Services at (701) 277-2196.

A complete list of Availity, LLC Specifications required to submit Washington and Oregon Medicare Part B claims is available on the Availity, LLC Web site, or you may contact the Availity, LLC EDI Helpline via phone at (877) 334-8446 or by e-mail THIN@THINEDI.com.

Please note, you may need to contact your software vendor to ensure your software is compliant with these specifications.

The Noridian EDI Form contains a Clearinghouse section which must be completed exactly as shown below to avoid any potential problems.

HIPAA insurance claims format requirements

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) has created new insurance claims format requirements. Medicare requires that all claims must be submitted using the new HIPAA content compliant format. Noridian Mutual Insurance Company (Noridian), the Medicare Part B claims administrator for Oregon and Washington, has created new data requirements for HIPAA compliant submission detailed below.

New Medicare Submitter ID Numbers
Noridian now requires all electronic claims submitters to obtain a new Medicare Submitter ID number to include when submitting claims, either directly or through a clearinghouse, for Medicare Part B payment.

To obtain your new Medicare Submitter ID in Oregon and Washington, complete a 837P Registration 4010A1 form available on the Noridian Web site, and return it to the address indicated on the form, or contact Noridian EDI Support Services at: (800) 849-7243.

New Medicare Payer / Receiver ID Number
The Regence Group's contracted clearinghouse, Availity, LLC, requires a new Medicare Payer / Receiver ID to be used with your new Medicare Part B Submitter ID.

The new Availity, LLC Medicare Payer / Receiver ID is: (5 digits required)

• Oregon OR001
• Washington WA001

Format Specifications
Include your new Medicare Submitter ID and the new Availity, LLC Medicare Part B Payer / Receiver ID for all claims as follows:

Steps to Ensure a Smooth Transition

• Obtain your new Medicare Part B Submitter ID from Noridian Medicare
• Begin using your new Submitter ID immediately
• Update the EMC data fields as instructed in the "Format Specifications" section with your new Medicare Part B Submitter ID
• Submit your Medicare Part B claims to Availity, LLC using a HIPAA content compliant format
  Availity, LLC will "localize" all formats to the HIPAA compliant format (i.e., 4010A1)

The Availity, LLC EDI Helpline is available to assist you with any questions, requests, or concerns you may have.

You can e-mail Availity, LLC at THIN@THINEDI.com, or call (877) 334-8446. The Availity, LLC EDI Helpline is available Monday through Friday, from 7 a.m. until 4 p.m., Pacific Time.