Electronic Billing Instructions

Billing Provider

Billing Provider Name

Individual Providers:

  • Enter each part of the name in separate fields
  • Use format: LASTNAME FIRSTNAME MIDDLEINITIAL (not required) Title (not recommended) – so the provider name is not all in the Last Name field.
  • No punctuation
  • Example EDI: NM1*85*1*SMITH*JOHN*A**
  • If your software does not allow name separation, please contact MHP Provider Services to discuss options.

Companies/Groups:

  • Enter as much of the full name as possible in the Last Name field.
  • Use format: GROUPNAME
  • No punctuation
  • Example EDI: NM1*85*2*SMITH RADIOLOGY GR****

Billing Provider Street Address

  • All Providers – 999 S ANYWHERE ST or PO BOX 999
  • No punctuation. N, E, S, W, NE, SW, etc. Standard USPS street-type abbreviations.
  • No additional address information required or processed for street.

Billing Provider City, State, Zip

  • Full city name as space allows and standard USPS 2-digit state abbreviation.
  • Important: 5-digit Zip Code
  • Each in a separate field.

Member Group Number

  • Member Group Number must be filled. Can be a default of: 999999
  • MEMBER – IL (same for QC dependent as applicable)

Member Name

  • Enter each part of the name in separate fields
  • Use format: LASTNAME FIRSTNAME MIDDLEINITIAL
  • NOTE: Incorrect spelling of name can cause rejection.

Medicaid ID

  • Member Identification # – MI – The member’s Medicaid ID # must be ten (10) digits or it will be REJECTED

Commercial ID

  • Member Identification # – MI – All must be exactly 7 digits or it will be REJECTED

Member Street, City, State, Zip

  • All Members – 999 S ANYWHERE ST or PO BOX 999
  • No punctuation. N, E, S, W, NE, SW, etc. Standard USPS street-type abbreviations.
  • No additional address information required or processed for street.

Member Date of Birth (and any other date)

  • YYYYMMDD – no punctuation
  • Example: 20030214

Claims Detail

  • Units – Units value cannot be zero (0).

Alternate Providers

Alternate Provider Name

  • Individual Providers – Enter each part of the name in separate fields
  • Use format LASTNAME FIRSTNAME MIDDLEINITIAL (not required) and Title (not recommended) so the provider name is not all in the Last Name field.
  • No punctuation

Companies/Groups

  • Enter as much of the full name as possible in the Last Name field

Alternate Provider Street Address – where applicable

  • All Providers – 999 S ANYWHERE ST or PO BOX 999
  • No punctuation. N, E, S, W, NE, SW, etc. Standard USPS street-type abbreviations.
  • No additional address information required or processed for street.

Alternate Provider City, State, Zip – where applicable

  • Full City name as space allows, and standard USPS 2-digit state abbreviation.
  • Important: 5-digit Zip Code
  • Each in a separate field.

McLaren Health Plan utilizes ENS Optum Insight as its preferred vendor for EDI claims submissions. To become a customer of ENS Optum Insight, or if you are already a customer and are having difficulty submitting claims electronically, please contact the ENS Optum Insight Services team at inform@optum.com. ENS Optum Insight has affiliations with the following clearinghouses:

  • Availity
  • ClaimLynx
  • Claim Logic
  • CPSI
  • Gateway EDI
  • MedAvant
  • Medical Claim Corp
  • Payer Path/MISYS
  • PerSe
  • Relay Health (McKesson)
  • Quadax
  • SSI Group
  • ZirMed

If you are a current customer of any of the above listed clearinghouses, your EDI claims will be routed through ENS Optum Insight, and no action is required.

If you have questions about the status of claim, contact Customer Service at (888) 327-0671.