Emblem Health HIPAA Claims

Emblem Health HIPAA Claims Electronic Submission

Emblem Health HIPAA Claims are received from thousands of health care practitioners that eliminated paper claims and are submitting electronic claims in HIPAA-compliant professional provider (837P), institutional provider (837I) and dental provider (837D) EDI claims transaction formats. When billing electronically, please allow a reasonable amount of time to complete your account receivable reconciliation process. Ensure that your billing system is not set up to automatically re-bill every 30 days. Many times the payment for the original claim was applied to the copay or the service was denied for medical necessity, eligibility or another reason. Please make sure that your automated billing system accurately posts patient responsibility data and claims settlement messages. Ensure that your billing system does not automatically generate a paper claim. This duplicate billing practice is costly and delays processing.

Advantages of Emblem Health HIPAA Claims Electronic Submission

  • Quicker claims submission, which means faster reimbursement to you
  • No paper claims to stock and complete
  • Simplified record keeping by eliminating lost claims paperwork
  • Reduced clerical time and the costs to process and mail paper claims

Pathways For Electronic Claim Submission To EmblemHealth

Providers, both institutional and professional, may use practice management system vendors, billing services or clearinghouses to submit claims and other EDI transactions to EmblemHealth. Practice management system vendors and billing services offer a variety of EDI solutions to the health care community and charge fees and/or transaction costs for their services. EmblemHealth does not specifically recommend or endorse any vendor or billing service.

Clean non-Medicare claims submitted electronically will be processed within 30 days; paper or facsimile clean non-Medicare claims will be processed within 45 days in accordance with the New York State law for prompt payment of claims. All claims submissions must include the TIN and NPI of the rendering and billing provider(s).

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