Please follow the Enrollment Instructions to become an electronic submitter for UHA.

Required Documents for those applying for new Submitter IDs

The following documents are required enrollment documents that must be completed, signed and returned to the UHA office prior to initiation of electronic claims submission or inquiry.


1. EDI 837P Professional Claim Registration

2. EDI 837I Institutional Claim Registration

3. ERA Request Form

If you are having trouble accessing the forms listed above, please download them from here:
http://www.uhahealth.com/providers/claims.asp

If you have any questions regarding any of the documents in this package, please call the UHA EDI Technology Support Center at 1-800-458-4600 ext 253.

We can now process 276/277 requests (claim status). If this is a transaction you would like to utilize please make sure to enroll with the payer.
 

837P Professional Claim Registration

1. Enter your Tax ID and NPI

2. Enter the Name and NPI numbers of the providers that you will be billing for

3. Complete your demographic information

4. Leave the clearinghouse section blank

5. Sign and Date the Bottom

837I Institutional Claim Registration

1. Enter your Tax ID and NPI

2. Enter the Facillity information

3. Complete your contact information

4. Leave the clearinghouse section blank

5. Sign and Date the Bottom

835 ERA Request Form

1. Enter your Provider Name and Address

2. Enter your Providers Tax ID and NPI

3. Enter your Contact information

4. Please re-enter your Tax ID and NPI

5. Please skip the Clearinghouse information section

6. Reason for Submission is "New ERA Enrollment"

7. Please print your name and sign

Trading Partner Agreement

Please complete the line on the first paragraph with your Business or Provider Name.
Complete the Trading Partner section on page 12 with your Business or Provider Information.
(Note: Exhibit B is only for Providers that use a Billing Service that does their billings on their behalf.)

Submitting your Forms

It is recommended that you keep a copy of all the forms you will be submitting for your records. Send the enrollment forms reflecting original signatures to:

Fax: 1-866-572-4383
Or email:
Hipaa-edi@uhahealth.com

It is very important that you complete and return the entire enrollment packet as described above. Incomplete packets will not be processed and will be returned to the submitter.

Waiting for a Response

Once the complete provider enrollment packet has been received, the documents will be processed. Processing will take approximately two weeks from the date of receipt. (Remember that mailing time can take as much as five days.)

After processing, a confirmation will be emailed to you as notification to begin filing claims electronically. If neither confirmation nor a returned packet is received after two weeks, contact the Technology Support Center toll-free at 1-800-458-4600 ext 253.

Testing

Once you have received your Submitter ID and Password from UHA, please call the Claimshuttle Support Team and set an appointment for a Mailbox setup and Test Transmission.

Please have 10 test claims ready for testing. Test files should consist of a variety of claims that represent the type of claims you will be submitting once production status is achieved. Test claims will not be processed for payment but will be validated against production files; therefore, they must contain valid patient procedure, diagnosis, and provider information.