EDI Claims Submission

EDI Claims Submission to Affinity Health Plan FAQs (Part 2)

EDI Claims Submission and cooperation guidelines for Affinity Health Plan partners were described in the previous posts of our blog. The first portion of EDI Claims Submission Affinity Health Plan FAQs can be found in the previous post. Today we continue to give more info about EDI Claims Submission to Affinity Health Plan. Find FAQs Part 2 listed below.

What electronic claim formats does Affinity accept?

Affinity will accept 837P and 837I transactions through the Emdeon clearinghouse. If you are unable to submit claims in any of the accepted formats identified in the 837P and 837I Companion Guides, please contact your billing system vendor.

How can I be sure Affinity is receiving our claims?

You should routinely review and load to your practice management system the confirmation and rejection reports supplied by your vendor and Emdeon each time you transmit to Affinity. These reports should be used to compare your actual submission totals against the totals shown on the reports. They will confirm which claims have reached their destination and which claims were rejected. If you do not currently receive these reports or you are unsure how to use them, please contact your vendor.

Regardless of your individual vendor, when you send a claim electronically to Affinity, it must be processed through Emdeon. At Emdeon, the claim goes through a set of standard edits to make sure the claim is error free. If the claim meets these standard requirements, Emdeon accepts the claim and forwards it to Affinity. If the claim is missing required information or does not meet Emdeon’s edits, Emdeon rejects the claim and the claim does not reach Affinity.

The following are Emdeon Reports that you should check to see if your claims were passed to them. They are listed by a report code. The report code can be found in the upper left-hand corner of your report. If your claims are filed electronically to an intermediary vendor first and then passed to Emdeon, please check with your vendor to ensure you are receiving comparable reports.

  • R022 Provider Daily Statistics Report

This report lists the totals of claims submitted, accepted, and rejected by Emdeon for all payers for that day. Accepted claims are forwarded on to the payers, rejected claims are not forwarded. Any rejected batches or claims are listed on this report including the reason they were rejected. These claims can then be corrected and re-submitted to Emdeon.

  • R023 Provider Daily Summary

This summary lists number of accepted claims per batch. It also contains a Provider Totals section that shows all input, accepted, and rejected statistics for that day, month-to-date, and year-to-date.

  • R026 Daily Acceptance Report

This report lists the claims accepted by Emdeon and forwarded to all payers.

  • R028 Provider Monthly Summary

This summary contains the Month-To-Date and Year-To-Date claim totals and statistics for providers.

HIPAA EDI Training in Los-Angeles (October, 2016)

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