WPS EDI

WPS EDI Express Enrollment Electronic Funds Transfer Guides WPS EDI Express Enrollment is a comprehensive and secure website for providers to enroll in Electronic Funds Transfers. The Multi Factor Authentication is an additional form of security to safe guard your information. User Checklist User Checklist Be prepared with the following information before proceeding with the Read More →

EDI overview

EDI Overview and Enrollment Procedures For Optima Health Providers EDI overview and requirements are to be used with the HIPAA-AS Implementation Guide. Each EDI vendor will have to sign a Trading Partner Agreement, which includes the Network Access Agreement and the Business Associate Agreement. EDI overview: Business Use Each transaction set will be used to expedite the execution of electronic Read More →

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 →

Claims Submission Changes

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 →

Claims Billing Errors

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

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

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 →