EmblemHealth Electronic Claims

EmblemHealth Electronic Claims (EDI Transactions) Requirements EmblemHealth Electronic Claims help practitioners manage their practices more effectively. EmblemHealth supports HIPAA-compliant electronic data interchange transactions. Electronic claims submission provides an easier, faster way to submit claims. Some of the advantages of electronic claim submission includes: Quicker claims submission, which means faster reimbursement to you. No paper claims to Read More →

Health Homes HIPAA Billing

Health Homes HIPAA Billing Enrollement Guidelines (EmblemHealth) Health Homes HIPAA Billing Enrollement provides receiving direct deposits to your bank account(s) with electronic remittance advice (ERA) through electronic funds transfers (EFT). The registration process is simple, secure, and takes just moments to complete: Step 1: Have available a recent EmblemHealth Explanation of Benefits (EOB) and, either a voided check, or Read More →

Health Homes Billing

Health Homes Billing – Claims Submission Guidelines (EmblemHealth) Health Homes Billing is released using electronic formats. Pursuant to the Health Insurance Portability and Accountability Act (HIPAA), Public Law 104-191, institutional providers who submit claims electronically are required to use the HIPAA 837 Institutional (837i) transaction. This is the preferred method of claims transmission. 837 transactions Read More →

EmblemHealth PNC Remittance

EmblemHealth PNC Remittance Advantage (No Cost EFT-ERA Program) EmblemHealth PNC Remittance Advantage program offers paperless claim payments and electronic remittances free of charge. EmblemHealth urges you to take advantage of this program. Electronic transactions are fast, convenient and lower the risk of lost or stolen payments. You will benefit from increased payment-processing efficiencies, cost reductions and Read More →

Taxonomy Codes

Taxonomy Codes: The Importance of Accurate Taxonomy Codes Taxonomy codes are administrative codes that identify your provider type and area of specialization. It is a unique ten character alphanumeric code that enables you to identify your specialty at the claim level. EmblemHealth wants to make sure you know how this will affect you and your EmblemHealth patients. Read More →

Taxonomy Codes

Taxonomy Codes: The Importance of Accurate Taxonomy Codes Taxonomy codes are administrative codes set for identifying the practitioner type and area of specialization for health care practitioners. Each taxonomy code is a unique ten character alphanumeric code that enables practitioners to identify their specialty at the claim level. Taxonomy codes are assigned at both the individual Read More →

HIPAA Claims

HIPAA Claims EmblemHealth: Look Back Periods To Reconcile Overpayments To ensure fair and accurate HIPAA claims payment, EmblemHealth conducts audits of previously adjudicated claims. The time period for these audits is referred to as the “Look Back Period.” HIPAA claims may be audited based on the settlement or paid/check date, not the date(s) of service. The date Read More →

Medicare Dual Eligible Members

Medicare Dual Eligible Members (EmblemHealth Billing Guides) Medicare Dual Eligible Members are individuals with both Medicare and Medicaid coverage. Depending on their category of Medicaid coverage, a dual eligible may receive state Medicaid plan assistance to cover their Medicare Part B premium, Medicare Parts A and B cost-share and certain benefits not covered by Medicare. Read More →

Billing the Member

Billing the Member or Secondary Payor (EmblemHealth Billing Requirements) Network providers, in agreeing to accept EmblemHealth’s Billing the Member and Secondary Payor requirements and reimbursement schedule for services rendered, shall not bill or seek payment from the member for any additional expenses (except for applicable copayments, co-insurance or permitted deductibles) including, but not limited to: The Read More →

EmblemHealth Claims Processing

EmblemHealth Claims Processing and Payment Guidelines EmblemHealth Claims Processing (clean non-Medicare claims) will be done 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 Read More →