Electronic Claims Processing Guidelines For Health Partners Plans Vendors
Electronic Claims Processing with Health Partners Plans allows to decrease administrative costs, avoid processing delays, increase your claim acceptance rates and productivity, receive records of claim receipts and detailed claims status. You can have speed, convenience and lower administrative costs through Electronic Data Interchange (EDI) or electronic claims processing. Health Partners Plans utilizes the Emdeon Transaction Services, also known as NEIC, ENVOY, or WebMD ENVOY claims clearinghouse.
To take the advantage of Electronic Claims Processing you should contact your billing software vendor and request that your Health Partners, KidzPartners or Health Partners Medicare claims be submitted through the Emdeon claims clearinghouse, or direct your current EDI clearinghouse to forward your claims to Emdeon.
For all claims (CMS-1500/837P and UB-04/837I) submitted electronically through the Emdeon clearinghouse, Health Partners Plans can electronically return a detailed status for each claim. The status message will show which claims were accepted, rejected and/or pending, and provide the amount paid on the submitted claim once it has been finalized.If you are an Emdeon submitter and you do not have the ability to receive Emdeon claims status, please contact your billing software vendor for more information.
Claim Submissions Revisions
For PCP/Specialists, Ancillary Providers, Hospitals and Non-Participating Providers:
- Members are assigned to a single provider rather than a group.
- When filling out UB-92 and HCFA-1500 claim forms
- Your Provider ID number is required.
Claims MUST be filled in properly or they will be rejected and returned to you for re-submission with the proper information.
To satisfy Department of Human Services (DHS) reporting requirements, Health Partners Plans providers must provide complete data on each encounter with a Health Partners member through a properly completed HCFA-1500 form.
All Health Partners Plans (Medicaid) claims must be submitted with the Member’s 9 digit Health Partners Plans ID number.