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MassHealth Electronic Data Interchange (EDI)

This is a part of the MassHealth Provider Handbook

Table of Contents

About EDI

Electronic Data Interchange (EDI) is a process that facilitates the exchange of data in a standardized message format between two computer systems. EDI is the industry standard terminology for electronic transactions.

EDI specifications and instructions to submit electronic transactions to MassHealth are based on the following documents:

  • ASC X12 Standards for Electronic Data Interchange Implementation Guide (IG)
  • MassHealth Companion Guide
  • MassHealth Billing Instructions (as applicable)

MassHealth supports the following Health Insurance Portability and Accountability Act (HIPAA) EDI transactions:

  • 270/271: Health Care Eligibility/ Benefit Inquiry and Information Response
  • 276/277: Health Care Claim Status Request and Response
  • 820: Health Care Premium Payment
  • 834: Health Care Benefit Enrollment and Maintenance Outbound
  • 835: Health Care Payment/Remittance Advice
  • 837I: Health Care Claim: Institutional
  • 837P: Health Care Claim: Professional

To access the MassHealth Companion guides, please go to the MassHealth Technical Refresh web page.

MassHealth will generate a 999 acknowledgement upon receipt of an electronic file. The 999 is a HIPAA transaction that acknowledges the receipt of a standard transaction and identifies whether the transaction will be accepted or rejected for downstream systems processing.

For more information regarding the 999 acknowledgement, including how to resolve issues and who to contact for assistance, please go to the Electronic Data Interchange web page.

Any MassHealth provider who intends to submit HIPAA EDI transactions to MassHealth must test each transaction with MassHealth prior to submitting any transactions in the production environment. Learn more about the HIPAA Testing process.

MassHealth maintains a MassHealth-Approved Vendor List, which provides the names, phone numbers, transaction types, and services of vendors that are approved to submit electronic HIPAA-compliant transactions to MassHealth. Learn more about the MassHealth-Approved Vendor list.

If you have questions about policies and procedures for testing or submitting HIPAA EDI transactions, or need technical support, contact MassHealth at (800) 841-2900 and follow the menu prompts for EDI Transactions, Monday through Friday from 8 a.m.–5 p.m., excluding holidays, or by email to edi@mahealth.net.

Date published: July 29, 2022

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