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 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 →

Claims Submission Changes (EmblemHealth Provider Updates) Claims submission changes listed in the blog refer to some new demands for providers sending HIPAA claims to EmblemHealth. Starting October 1, 2018, eviCore began to process claims for radiology services performed by radiologists for ACPNY members. Claims sent to EmblemHealth after October 1, 2018 will be denied, indicating that the claim Read More →

Top Ten Claims Billing Errors For Highmark Healthcare Providers Top Ten Claims Billing Errors  have been identified to help providers send and process claims correctly. Incorrect provider number listed – Generally, the billing provider number is the assignment account, while the performing provider number is the individual practitioner. If practices are unsure which National Provider Identifier (NPI) to Read More →

HIPAA Billing Internal Dispute Process At Highmark HIPAA billing dispute regarding claims payment decisions made by Highmark can be requested by any provider that treats a Highmark member. Any claim dispute between a provider and Highmark arising from a provider’s request for payment is solely a contract dispute between the provider and Highmark, and does not involve Read More →

HIPAA Claim Investigation (Highmark) HIPAA claim investigation is the ordinary means providers use to communicate their questions regarding pending, paid, or denied claims. An investigation should be submitted if the provider has a question about the status of a claim. Complete research should be completed by the provider prior to submitting the investigation. A claim investigation Read More →

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 Read More →

Remittance Advice Guidelines (Palmetto GBA Providers) Remittance Advice is sent to nonparticipating physicians, suppliers, and non-physician practitioners billing non-assigned claims, unless the beneficiary or the provider requests that the remittance advice be suppressed. An informational Remittance Advice is identical to other RAs, but must carry a standard message to notify providers that they do not have Read More →

EDI Claims Electronic Submission (Palmetto GBA Guidelines) EDI Claims Electronic Submission is released via telephone lines, via a modem, to Palmetto GBA. EDI Claims Electronic Submission gives the provider control over the timeliness and accuracy of the claims entry by eliminating the need for mailroom processing and manual data entry by Palmetto GBA. Payment for ‘clean Read More →

HIPAA Claims Filing Requirements For Palmetto GBA Providers HIPAA Claims Filing requirements by Palmetto GBA require providers to submit claims for all Medicare patients for services rendered. HIPAA Claims Filing requirements apply to all physicians and suppliers who provide covered services to Medicare beneficiaries. You may not charge your patients for preparing or filing a Medicare claim. The requirement Read More →