HIPAA Transactions

The companion guides below include specific details for the EDI transactions we offer and support. If you are interested in submitting electronic transactions to Prevea360 Health Plan, download and complete the applicable EDI setup form(s) below.

The EDI setup forms below are fillable PDFs. Complete the EDI setup forms by filling them out electronically and saving the file. Once completed, send the PDF as an attachment in an email to the EDI Team.   

Transaction Transaction Number Companion Guide/ Help Materials EDI Setup Form
Health Care Eligibility Benefit Inquiry and Response
270/271
Companion Guide  270 EDI Setup Form 
Provider Portal Alternative to EDI requests and responses: Benefits Eligibility can also be confirmed real-time through our Provider Portal. Visit Tools & Resources for additional information on the Provider Portal. To enroll, contact our Provider Network Liaison at (877) 230-7571. n/a
Health Care Claim Status (for claims accepted for adjudication)
276/277

Companion Guide 

276 EDI Setup Form 
Provider Portal
Alternative to EDI requests and responses: Claim status can also be confirmed real-time through our Provider Portal. Visit Tools & Resources for additional information on the Provider Portal. To enroll, contact our Provider Network Liaison at (877) 230-7571.
n/a
Health Care Claim Acknowledgment (for claims accepted or rejected for adjudication) 277CA Companion Guide  277CA EDI Setup Form 
Confirmation Reports Portal Alternative to EDI requests and responses: Claim acknowledgment can also be confirmed through our Confirmation Reports Portal. Visit Tools & Resources for additional information on the Confirmation Reports Portal. To enroll, contact our Provider Network Liaison at (877) 230-7571. n/a
Benefit Enrollment and Maintenance 834 Companion Guide 
Health Care Claim Payment/Advice 835

Companion Guide
We have partnered with Change Healthcare for the exchange of both paper explanation of payments and checks as well as electronic remittance advices and electronic funds transfers. Enroll with Change Healthcare ePayment Services at 
(866) 506-2830 or online Enrollment Services Website.

n/a
Health Care Claim
Institutional & Professional
837 Companion Guide 
Stream Clearinghouse Portal
We have partnered with SmartData Solutions to offer claim submissions by manually keying in the claim informaiton and submitting them electronically through the SmartData Stream ClearingHouse Portal. There is no cost for providers or trading partners who submit claims using this portal. Rejected claims can also be corrected and resubmitted through this poral. Register by contacting Smart Data Solutions at 855-297-4436 or online through the Account Creation Page for Payer Enrollments webpage
n/a

Contact us

edi@prevea360.com
Phone: 800-356-7344, ext. 4320
 

Scheduled downtime

  • Third weekend of every month
    • 10 pm Saturday to 11 am Sunday – vendor monthly systems maintenance. Can result in intermittent outages for real-time transactions related to Medicare Advantage plans.
    • 6 pm Sunday to 2 am Monday – Prevea360 systems maintenance. Will affect all real-time transactions.
  • Fourth weekend of every month
    • 8 pm Saturday to 2 am Sunday – vendor monthly systems maintenance. Will affect all real-time transactions.