Electronic Data Interchange (EDI) Simplifying electronic claims submission

What is EDI?

Electronic data interchange (EDI) is a powerful tool for increasing office productivity and improving cash flow. The benefits of the EDI services offered by AmeriHealth include:

• Faster processing and timely error reporting for claims
• Automated posting of claim payments
• Real-time verification of a patient’s coverage and cost-sharing responsibility

Getting started with EDI

To start conducting EDI business with AmeriHealth, please take the following steps:

• Get your NPI and register it with AmeriHealth.
• Select a trading partner or sign up as your own trading partner.
• Affiliate your NPI with your trading partner to enable electronic transactions.

Smart Data Solutions (SDS) provides the Stream Clearinghouse to handle EDI transactions on behalf of AmeriHealth.

Visit the Trading Partner Business Center for an overview of the registration process and to review the Trading Partner Registration Guide. You can also access commonly used resources and instructions to make changes to your Trading Partner account.

For changes to your Electronic Remittance Advice (ERA), please submit your request to both:

• SDS. Visit the Make Changes section of the Trading Partner Information Center.
• PNC Healthcare.* Submit an EFT and ERA Enrollment Form to ensure your EFT transactions are appropriately handled for all our vendor platforms.

If you have questions related to conducting EDI business with AmeriHealth via the Stream Clearinghouse, please contact the SDS support team Monday – Friday, 8 a.m. – 5 p.m. ET at stream.support@sdata.us or 1-855-297-4436.

*As of January 1, 2024, medical claim payments and remittances for members on the new platform and all capitation payments will be issued from PNC Bank's Claim Payments & Remittances (CPR) service, powered by ECHO Health.