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: 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 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 (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 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 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 →

EmblemHealth Electronic Claims Submission Requirements EmblemHealth Electronic Claims should not be duplicated. When duplicate claims are submitted, vendor potentially delays claims processing and create confusion for the member. Attachments cannot be submitted electronically at this time. However, most claims should be submitted electronically. If supporting documentation is required for the settlement of a vendor claim, EmblemHealth will request it. Read More →

Electronic Remittance Advice And Electronic Funds Transfer for EmblemHealth Claims Electronic Remittance Advice and Electronic Funds Transfer are the standards for receiving EmblemHealth payments. Electronic Remittance Advice can be processed via PNC Remittance Advantage, a no-cost online payment solution that helps your office reduce payment processing expenses and improve cash flow. With PNC Remittance Advantage, you can receive Read More →

National Provider Identifier Requirements (EmblemHealth Electronic Claims Submission) National Provider Identifier (NPI) should be checked by vendor practice management system to ensure vendor software is capturing and correctly populating a National Provider Identifier (NPI) in electronic claims, otherwise claims will be rejected by EmblemHealth. Please note the following NPI requirements for electronic health care claim submissions: Professional Provider Read More →

Benefits Of Electronic Claims Submissions At (Highmark Billing & Payment) Benefits Of Electronic Claims – convenient, confidential, and operational around the clock. All it takes is a computer, the proper software, and an Internet connection for electronic claims submission. Instead of printing, bundling, and sending paper claims through the mail, simply enter and store claims data through your Read More →