Claims

Electronic Claims are claims submitted electronically through a Plan-approved electronic billing system software vendor or clearing-house. Completion of electronic claim submission requirements can speed claim processing and prevent delays.

If you use EDI, you must include:

• Billing Provider Name
• Rendering Provider
• Legal Name
• License Number (if applicable)
• Medicare Number (if applicable)
• Federal Provider Tax ID Number
• Medi-Cal ID Number (if applicable)
• National Provider Identifier (NPI)

We cannot be responsible for claims never received. Providers must work with their vendors to ensure files are successfully submitted to us. Failure of a third party to submit a claim to us may risk the Providers claim being denied for untimely filing if those claims are not successfully submitted during the filing limit.

Paper claims are scanned for optimal processing and recording of data provided; therefore, even paper claims must be legible and provided in the appropriate format to ensure scanning capabilities. The following paper claim submission requirements can speed claim processing and prevent delays:

• Use the appropriate form type for submission
• Use black or blue ink; do not use red ink, as the scanner may not be able to read it
• Use the Remarks field for messages
• Do not stamp or write over boxes on the claim form
• Send the original claim form to us and retain the copy for your records
• Separate each individual claim form. Do not staple original claims together, as we would consider the second claim an attachment and not an original claim to be processed separately
• Information is typed within the designated area of the field. Be sure the type falls completely within the text space and is properly aligned with corresponding information. If using a dot matrix printer, do not use draft mode since the characters generally do not have enough distinction and clarity for the optical character reader to accurately determine the contents

Greater Tri Cities IPA (GTCIPA) has partnered with InstaMed, the leading healthcare payments network, to offer a free solution to deliver your payments as Electronic Remittance Advice (ERA) and Electronic Funds Transfer (EFT). You can register to receive GTCIPA ERA/EFT payments today at www.instamed.com/eraeft.

ERA/EFT is a convenient, paperless and secure way to receive claim payments. Funds are deposited directly into your designated bank account. The benefits of ERA/EFT include:

• Accelerated access to funds with direct deposit into your existing bank account
• Reduced administrative costs by eliminating paper checks and remittances
• No disruption to your current workflow – there is an option to have ERAs routed to your existing clearinghouse

You have two simple options to register to receive GTCIPA payments as free ERA/EFT transactions:

1. Online: visit www.instamed.com/eraeft
2. Paper: complete the enclosed Network Funding Agreement and fax it to (877) 755-3392

All electronic payments and EOB’s will be provided by InstaMed. This includes providers that sign up for electronic payment as well as those providers that did not sign up. For those providers that do not sign up, hard copy checks and EOB’s will be mailed from InstaMed instead of PDT.

This notice was mailed to all PCP’s. However, it is important to note that “Capitation Payment” will not be paid electronically. InstaMed will provide hard copy checks and remittance advise (RA’s) to all PCP’s .

PCP’s can sign up to receive FFS payment electronically.

Please do not hesitate to contact InstaMed directly at (866) 945-7990 or connect@instamed.com with any questions.

Is Online Registration secure?
Yes. InstaMed places the highest importance on data integrity, security and compliance. InstaMed meets the highest industry standards for compliance and security, including Payment Card Industry (PCI) Level One and verification processes to prevent fraud. For details about InstaMed compliance standards, visit www.instamed.com/about/compliance-and-security.

What information is needed during Online Registration?

• Tax ID
• Email Address
• Legal Business Name
• Business Address/Phone
• Principal Name (primary decision maker)
• Billing NPI Number
• Bank Name
• Bank Routing Number

How will I receive my ERAs?
You have multiple options to receive your ERAs. Upon registering for InstaMed, you will receive access to InstaMed Online, a free, secure provider portal that will allow you to access payment details 24/7 and view and print remittances. You also have the option to have ERAs routed to your existing clearinghouse. Finally, you have the option to have an SFTP folder set up. Please contact InstaMed at connect@instamed.com or (866) 945-7990 with any questions on ERA delivery.

Will I still receive paper EOBs in the mail?
No. Once your register for ERA/EFT, you will stop receiving paper checks and mailed EOBs.

How will I know when I get paid?
You will receive email alerts to notify you when a payment is made, so you can easily track all payments. Additionally, you will have 24/7 access to reporting with InstaMed.

Which NPIs do I provide?
Please enter your Type 2 NPI(s) during Online Registration since they are used for billing claims.

What if I have multiple Tax IDs?
Once you register, you may add additional Tax IDs to your account.

Who is the contact vs. the principal?
The principal is the primary decision maker, i.e. director or owner. The contact is the person who will be the administrator on the account. The contact may be the principal or an authorized representative of the organization.

Which email address should I enter during Online Registration?
InstaMed will send an email to this address to confirm registration, so this should be an email address you want to use for your InstaMed account.

Why do I need to enter details about my business during Online Registration, including date established?
In order to prevent fraud, we use this information to verify your organization.

What is the turnaround time between registering online and receiving payments?
After you register online, it takes about 8 to 10 business days to receive your first payment, because InstaMed completes a thorough verification process to ensure your bank account information is secure.

I’m a billing service. Why should I register?
We work directly with you, the billing service, enabling you to manage payments for your providers as you do today, but with tools to make your processes more efficient. Plus, you manage all of the payments and reports for providers all in one place, and enhance your offering to providers by enabling them to receive the payments faster.