Phoenix Health Plan EDI

Phoenix Health Plan EDI Claims Submission Guidelines

Phoenix Health Plan EDI department encourages providers to consider electronic claims submission (EDI – 837) for your practice. There are many advantages to submitting Phoenix Health Plan EDI claims electronically (decreased submission costs, faster processing and reimbursement, allows for documentation of timely filing, etc).

However, any claims requiring attachments, must be submitted on paper.

Phoenix Health Plan EDI Claims Submission supposes 2 forms of payment for services provided; paper check and electronic funds transfer (direct deposit).

Electronic Funds Transfer (EFT)/Electronic Remittance Advice (ERA)

Electronic funds transfer (EFT) is the electronic exchange of Phoenix Health Plan EDI Claims payments and collections. It is safe, secure, efficient and less expensive than paper check payments. EFT allows payments to be deposited electronically directly into a designated bank account. Some of the benefits of EFT are:

  • Receipt of payment directly into your account within an average of 3-5 business days once payment is released.
  • No need to manually deposit your checks.
  • Capability to view remits on-line through our secure website.
  • Allows for no delay between receipt of dollars and the ability to post payment.

Electronic remittance advice is an electronic transaction that enables you to receive claims payment information electronically. The ERA files are transmitted to our vendors/clearinghouse in the HIPAA mandated ASC X12 835 5010 A1 format. ERA allows providers to post ERA electronically to your billing software vendor or clearinghouse and to automate manual processes.

Providers that are registered through Phoenix Health Plan website for secured access can check status of their submitted claims. Once Phoenix Health Plan EDI claims have been data entered, claims will reflect as showing pending, paid or denied.

CMS 1500 Submissions

For providers who submit for reimbursement on a CMS 1500 form, the facility’s NPI number must appear in box 33a along with the provider’s facility name as registered with the IRS in box 33 along with the rendering provider’s NPI in box 24j If you do not have a facility NPI, the rendering physicians NPI number must appear in box 33a.

Tax Identification Number

Each provider must report the tax I.D. number under which they wish to be paid. It is imperative that PHP be notified of any tax I.D. number or name changes. Failure to provide the health plan with tax I.D. or name changes may result in denial of claims or backup withholding per IRS guidelines. As a reminder, all claims should be submitted with the W-9 legal entity name in Box 33 and not the DBA (doing business as) name. PHP does not accept business names unless you are registered with the IRS to use that name.

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