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Client Companion Guide for MultiPlan Direct EDI Clients

Client Companion Guide for MultiPlan Direct EDI Clients 2025

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The 'Client Companion Guide for MultiPlan Direct EDI Clients' provides detailed instructions and requirements for submitting HIPAA-compliant claims using the 837P and 837I transaction sets. It outlines essential mapping guidelines, data elements needed for successful claim processing, and specific considerations for various claim types, including Workers' Compensation and Auto Medical claims. The document also includes appendices with modifier codes, data elements for fee negotiation services, network codes, and repricing reason codes to assist clients in navigating the MultiPlan EDI system effectively.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is an EDI companion guide?

Our Electronic Data Interchange (EDI) Companion Guides describe specific requirements for trading partners who exchange electronic transactions directly with Blue Shield of California Promise Health Plan (not through a vendor or clearinghouse).

What is the timely filing limit for MultiPlan provider appeal?

In addition, the request for appeal must be received by MultiPlan within thirty (30) days of the date of the rejection/termination letter.

What is the timely filing limit for the health Alliance appeal?

How long do I have to send my appeal? For a first level appeal, you must send your appeal to Medical Mutual within 180 days of receiving your initial denial notice or as otherwise indicated in your Certificate or Benefit Booklet for subsequent appeals, if applicable. When will I receive a written response?

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