Affinity Health Plan 837 Claims: Electronic Claims Submission
Find out the third part of Affinity Health Plan 837 Claims FAQs regarding to Affinity Health Plan Electronic Data Interchange program. Affinity Health Plan 837 Claims FAQs present additional information useful for all parties taking part in claims submission.
Affinity Health Plan 837 Claims FAQs
Why is Affinity not receiving our transmission?
This problem could result from several different areas. Please review the items below to determine the most viable solution:
- Verify that all claims are transmitted to Affinity from both your vendor and Emdeon by reviewing your confirmation/rejection reports daily.
- Make certain all eligible claims in your system are flagged to go out electronically to Emdeon using Affinity’s Payer IDs.
- Check with your vendor to verify they are receiving all of your claims.
- Ask your vendor to contact Emdeon to verify that all of your claims are received by Emdeon.
- Some vendors require an additional number for electronic routing unique to their vendor requirements or even reference the actual payer address/name information passed to determine electronic routing. Please check with your vendor to determine vendor specific edits for routing claims electronically to Affinity.
Why is Affinity receiving paper claims from us when we transmit electronically?
Some vendors offer a service that automatically converts electronic claims to paper if they are rejected during transmission to the next vendor (usually the Emdeon clearinghouse). Review your Emdeon rejection reports and contact your vendor to discuss how they handle rejected claims.
Should I submit the same claims electronically AND by paper just to be sure it is received?
No. Please choose either paper or electronic filing, never both. Filing twice, by paper and electronic, will result in duplicated claim handling by Affinity.
Should I submit claims for capitated services electronically?
Yes. Affinity Health Plan processes claims and encounters through the same system. It is important to submit claims and/or encounters for all services rendered. Affinity will continue to include these claims in the remittance advice with a message the service is covered under a capitation arrangement.
Does Affinity provide Electronic Remittance Advice (ERA)?
Affinity offers an ERA/EFT solution with our partner clearinghouse, Emdeon, for our Medicaid, Family Health Plus, and Child Health Plus product lines only. Please contact Emdeon directly to enroll at http://www.emdeon.com/epayment/ or 866-506-2830. You will need to contact Emdeon directly even you use another clearinghouse besides Emdeon. The process is fast and simple and EFTs will start within the next 7 to 10 days following enrollment. It should be noted that you will continue to receive paper EOPs as well as your 835 ERA for a period of 45 days following enrollment so plan accordingly to be sure you can accept and load your ERA data.