HIPAA transactions
We support all HIPAA-compliant electronic transactions. As a component of The Health Insurance Portability and Accountability Act (HIPAA), it is required that all medical records, billing and patient accounts meet consistent documentation, handling and privacy standards.
Payer ID 39113
If you are interested in submitting Electronic Data Interchange (EDI) transactions for member eligibility, claim submission, claim acknowledgement, and/or claim status; please download and complete our EDI setup form. The EDI setup form below is a fillable PDF. Complete the EDI setup form by filling it out electronically and saving the file. Once completed, send the PDF as an attachment in an email to edi@deancare.com.
EDI transaction type | EDI transaction number | Connection setup | Alternative to EDI |
| Eligibility inquiry and response | 270/271 | Real-time connection available through our clearinghouse - Smart Data Solutions. | Benefit eligibility can be confirmed real-time through our provider portal. |
| Claim submission | 837 | Claim submission and acknowledgement responses through our clearinghouse - Smart Data Solutions. | We have partnered with Smart Data Solutions to offer claim submissions by manually keying in the claim information and submitting them electronically through the Smart Data Stream Clearinghouse Services 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 portal. Register by contacting Smart Data Solutions at 1-855-297-4436 or online through the account creation page for payer enrollments webpage. |
| Claim acknowledgement | 277CA | Claim submission and acknowledgement responses through our clearinghouse - Smart Data Solutions. | Claim acknowledgment (used for claims that were accepted or rejected for adjudication) can be confirmed through our confirmation reports portal. |
| Claims status inquiry and response | 276/277 | Real-time connection available through our clearinghouse - Smart Data Solutions. | Claim status can be confirmed in real time through our provider portal. |
| Payment/Advice (explanation of payment) | 835 | 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. Please visit Change Healthcare's payer enrollment services webpage. | A provider can view and download a copy of the explanation of payment by claim ID through our provider portal. |
Scheduled downtime
(All times CST)
Weekly:
- 7 to 11 p.m. Thursday – Our plan weekly changes. This may result in intermittent outages for real-time transactions.
First weekend of every month:
- 8 p.m. Sunday to 12 a.m. Monday - Our plan systems maintenance. This can result in intermittent outages for all real-time transactions.
Fourth weekend of every month:
- 8 p.m. Saturday to 2 a.m. Sunday – Vendor monthly systems maintenance. This can result in intermittent outages for all real-time transactions.
- 9 p.m. Saturday to 1 p.m. Sunday – Vendor monthly systems maintenance. This can result in intermittent outages for real-time transactions related to Medicare Advantage plans.
- 6 p.m. Sunday to 12 a.m. Monday - Our plan systems maintenance. This will affect all real-time transactions.
Contact us
If you have any questions, please contact the EDI support team for Payer ID 39113 at edi@deancare.com.
Payer ID 41822
Availity is the EDI clearinghouse for HIPAA transactions under payer ID 41822. Go to the Availity EDI Gateway for EDI setup.
Payer ID 75261
Dean Health Plan currently partners with WebTPA, a third-party administrator based in Texas, for claims processing and eligibility. Dean Health Plan works with WebTPA under a private label agreement that labels all services as "Dean Health Plan." Medical management, account management, provider services, contracting and subrogation are performed in Madison, Wisconsin.