FAQs
Who do I call for help getting started with filing claims electronically or for any EDI questions I may have?
A knowledgeable Emdeon customer support representative will assist you with any issues you encounter in submitting claims electronically.
Commercial Claims Support
1-800-845-6592
- HIPAA - Press 0
- Enrollment & Set Up - Press 1
- Batch Claims Support - Press 2
- Dental - Press 2
- Reports & Rejections - Press 3
- Reports & Rejections for Medicare and Medicaid Claims - Press 4
EDI Specialists
1-888-598-0731
- Submitting more of your claims electronically to your insurance payers
- Payer-specific information to submit electronic transactions
EDI Tips and Payer EDI Fact Sheets
http://www.emdeon.com/Transact
Emdeon Products and Services
1-877-469-3263
Option 2: Support for existing Emdeon product customers for:
- Lab transactions
- Clinical transactions
- Enrollment
- Billing questions
Option 3: Obtaining access to Emdeon products and services
- Emdeon Office
- Genesis Point of Service (POS) terminal
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How do I know what Payers will accept my claims electronically?
For a complete and current list of Payers click http://www.emdeon.com/PayerLists/payerlists.php or cut and paste this URL into your browser. The Emdeon Payer Lists identify insurance carriers accepting transactions through Emdeon. The Payer Lists also identify those payers that require additional enrollment procedures prior to submission. Whenever possible, Emdeon forwards the transaction electronically to the payer for processing. If necessary, we will forward a paper claim. The Emdeon Payer Lists are updated monthly. Payer Lists are available in Adobe Acrobat Portable Document Format (PDF) or a compressed PDF file using the WinZip (ZIP) format.
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Where do I find the Payer ID number?
Payer EDI Fact Sheets list the Payer ID for each payer, and can be found by selecting the corresponding payer from the menu found in the upper-left-hand corner of each page of this website. You may also contact the Payer directly. If you have a practice management system with unique payer ids, you will want to contact your vendor to obtain cross-reference ID.
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Why do I need to include my Provider number?
Some payers assign a proprietary provider number and require this number to be on a claim. The insurance payer's claims processing and adjudication system needs to be able to match your payer specific provider number and Tax ID to ensure appropriate payment. Check the Payer's EDI Fact Sheet for electronic claims submission requirements by selecting their Payer EDI Fact Sheet from any page of the EDI Resource Center in the upper left corner under Payer EDI Fact Sheets.
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Where do I find my Provider number?
You can find your provider number by contacting the payer or via "Find Provider" if you are a current Emdeon Office user. Some payers offer guidance to locate your provider number on their Payer EDI Fact Sheet. Select a Payer EDI Fact Sheet from any page of the EDI Resource Center in the upper left corner under Payer EDI Fact Sheets.
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What if I have attachments to include? Am I able to submit my claims electronically?
Many insurance payers have eliminated or significantly reduced the need for paper attachments and prefer to receive your claims electronically. If additional information is needed to process the claim, payers will request on an Explanation of Benefits (EOB) and/or via electronic report. In many cases, attachments are no longer required for referrals, progress and operative notes, ER visits, etc. To stay current with the payers' latest attachment requirements, file the claim electronically and let them ask if additional information is needed. Payer EDI Fact Sheets contain payer's preference in receiving attachments and can be found by selecting the corresponding Payer EDI Fact Sheet from any page of the EDI Resource Center in the upper left corner under Payer EDI Fact Sheets.
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When claim is not processed, how do I resubmit it?
When a claim is not processed because additional information is required, correct the claim in your practice management system and resubmit electronically. If a paper attachment is required, many payers provide fax or other capabilities to accept required attachments and still enable you to resubmit the claim electronically. Requirements will vary by payer. Check the Payer Fact Sheet by selecting the corresponding Payer EDI Fact Sheet from any page of the EDI Resource Center in the upper left corner under Payer EDI Fact Sheets, or contact the payer directly. If a claim was not processed because it was rejected by the clearinghouse or payer, correct the claim in your practice management system and re-file electronically. If a rejected claim correctly included all required information, resubmission on paper or electronically, will not change the adjudication or payment of the claim. Contact vendor, clearinghouse, or payer to resolve issue.
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Who do I call about my Explanation of Benefits?
Please contact the appropriate insurance company directly.
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What happens when I submit paper claims and I never hear back?
Paper claims do not allow you to track them as consistently or thoroughly as electronic claims. Paper claims may inadvertently be sent to the wrong payer or may be lost in the mail. Submitting claims electronically allows you to track the status of the claim from the time it leaves your office, through receipt at the vendor, clearinghouse and insurance payer, and, based on the ability of payers' systems, through the payers' adjudication process.
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If my claim rejects at the vendor or clearinghouse, who should I contact?
Contact your practice management vendor (the vendor that supplies and supports your office computer system).
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If the patient last name does not match the health insurance payer information, what should I do?
Submit the claim with the name exactly as it is listed in the payers' system or on the ID card. To ensure that you have the most up-to-date information, use electronic eligibility inquiry.
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If the patient date of birth does not match the health insurance payer information, what should I do?
Submit the claim with the patient date of birth exactly as it is listed in the payers' system. To ensure that you have the most up-to-date information, use electronic eligibility inquiry. Do not send "00" for the month or the date; ensure that the date of birth of the patient is not after the date of service for the claim.
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How do I know what dates are valid for submitting claims?
Verify that the proper date format is being used. Please contact your vendor to modify or correct date formats. Ensure that you are using a valid code for that date of service (e.g. a 2003 code cannot be successfully used with a 2004 date of service)
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How do I know what codes are valid for submitting claims?
Verify that you are using HIPAA compliant codes (HCPCs, CPT, ICD9, Modifiers, Revenue, Bill Type, Occurrence, etc)
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For Anesthesia claims, how do I handle unit conversions?
Some payers can accept units, some minutes, and some either. Payers may also have additional requirements for anesthesia claims, but most can accept anesthesia claims electronically. For payer specific requirements, check the Payer EDI Fact Sheet by selecting the corresponding Payer from any page of the EDI Resource Center in the upper left corner under Payer EDI Fact Sheets.
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How do I handle secondary claims?
Some secondary claims can be sent electronically. Requirements will vary by payer. Check the payer fact sheet by selecting the corresponding Payer from any page of the EDI Resource Center in the upper left corner under Payer EDI Fact Sheets or contact the payer directly.
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I don't have time to read my reports.
Reading and working the claims submission and error reports from your vendor and from Emdeon are critical and will save you money and time. Start by:
- Verifying that the number of claims and their dollar amounts you generated out of your system matches the numbers received.
- Check to see if any claims rejected. Then, correct in your practice management system and resubmit claims electronically.
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How do I know if I am submitting all claims electronically?
- Check to see that the payers' tables in your computer system are set to generate electronic claims vs. paper claims. If you have any questions, please contact your vendor.
- Some offices have front desk staff creating new patient records and creating additional payer listings without setting the claims as electronic. Review your internal office procedures to ensure that new patients are being set up properly.
- Many payers have only one electronic Payer ID, but offices set up multiple versions for the payer because of the physical payer address. Make sure the payer spelling and set up is consistent and set as electronic.
- Most systems have automatic claim re-bill capability that resends claims every 30/45/60 days if payment has not been posted. Setting your re-bills to electronic submission vs. paper assures that you have an electronic record of claim submission.
- Resolve rejected claim issues promptly. Some rejections may pertain to system setup (i.e. provider number transposed) that cause many rejections but are easily resolved.
- Ask your Practice Management Software Vendor to see monthly report of common rejections.
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