EDI Information Letter to Providers
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- Brent Malone
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1 EDI Information Letter to Providers Date: March 31, 2011 Attention: From: Electronic Claims Manager Deb Wallenstein, EDI Business Analyst or Susan Naanes, EDI Information Services (503) Information Services (503) Re: Electronic Claims Vendor Information We have several vendors to choose from that should be able to work with your system. Below is our list of contracted vendors and some information in helping to decide which vendor would work best for your office. PHP offers free electronic claim transaction fees for our members, so there will be little cost to you to send claims electronically. Electronic claims are paid on an average of 10 business days. Vendor Name Contact Information Transaction Availity Contact your Availity representative, for electronic claims information */MedAvant CareVu Or Ext. 812 Contact your CareVu representative for electronic claims information or
2 Vendor Name Contact Information Transaction eclaims Contact your eclaims EDI representative for electronic claims information EDI Healthcare *Emdeon Envoy/WebMD/Sage ENS Contact EDI Healthcare for electronic claim information. or Contact your ENS representative for electronic claims information. or PPO = not set up Professional & Intuitional claims 835 Electronic Remittance Advice (ERA) Health Plans = SX133 ET&T Health Plans = SX133 *FCHN Professional & Washington providers = Institutional claims (not Vancouver) Gateway EDI Contact your Gateway EDI representative for electronic claims information or GE Healthcare/Centricity/ IDX GHN Health-e-Web Contact your GE Healthcare representative for electronic claims information Contact GHN for electronic claim information or Contact Health-e-Web EDI representative for electronic claims information Health Plans = SX133 PPO = not set up Health Plans = SX133 Health Fusion Emdeon Emdeon Emdeon and 2
3 Vendor Name Contact Information Transaction *MCPS - Medical Claims MCPS Processing Solutions mcp@mcps-inc.com Institutional claims Steve Singer (at AMB) Misys and PayerPath Navicure Steves@ambpro.com ext. 12 Contact Misys for electronic claim information Contact Navicure for Providence payer ids or Health Plans = ORD02 PPO = ORD14 Health Plans = PPO = Health Plans = P1238 PPO = RelayHealth and *Office Ally info@officeally.com *Payer Connection Payer Path/Allscripts See Misys products@payerconnections.com or PPO = PPOOR Premera Blue Cross for detailed information Health Plans = RealMed *RelayHealth/McKesson Contact your RelayHealth representative for electronic claims information or call Institutional claims.. Health Plans = SX133 Health Plans Professional = 4498 Institutional = 1540 PPO Professional = 2403 Institutional = 1915 Emdeon and 3
4 Vendor Name Contact Information Transaction *RelayHealth/National Data Corp (NDC) *RelayHealth/Per Se Technologies *SSI Group WebMD/Envoy/Emdeon Sage ZirMed Contact your RelayHealth representative for electronic claims information or call need to fill out an enrollment form Contact ZirMed for electronic claim information or *Indicates a direct connection with PHP and clearinghouse. Institutional claims only. Institutional claims. 835 Electronic Remittance (ERA) institutional claims Health Plans Professional = 4498 Institutional = 1540 PPO Professional = 2403 Institutional = 1915 Health Plans = PPO = Contact vendor for Payer ID s. Health Plans = SX133 Health Plans = CPID 4498 PPO = CPID 2403 RelayHealth If your clearinghouse is not listed, contact your vendor to check if they have a connection to one of the listed clearinghouses. Also check the internet for payer ID s by looking for your clearinghouse and finding the payer identification list. 835 Electronic Remittance. If you are interested in receiving the 835 Electronic Remittance from Providence, please contact your clearinghouse. Your clearinghouse will set up the ERA for you. Once ready, the clearinghouse will contact Deb Wallenstein or Susan Naanes to start sending your data. The ERA will be available on Mondays and Wednesdays of each week from your clearinghouse. Along with the ERA, you will continue to receive the paper EOP s until you notify Providence to stop sending paper Should you have any questions regarding electronic data, please contact your Providence Health Plans Provider Relations Representative, Deb Wallenstein (Debra.Wallenstein@Providence.org) or Susan Naanes (Susan.Naanes@Providence.org). 4
5 **PHP does not pay for any costs associated with submission of paper claim 5
6 6
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