E-Commerce Enrollment

Transcription

1 Electronic Claims Submission HCIQ will electronically submit your primary carrier, professional claims. Please refer to our payer list to view the insurance companies that we currently submit to. Electronic Remittance Statements HCIQ will post any electronic remittance statements received by the insurance companies to the HCIQ Message Center. The files can be downloaded and posted into your billing system. Please refer to our payer list to view the insurance companies that provide electronic remittance statements. Electronic Claims Status HCIQ provides electronic claims status via the HCIQ Message Center. Please refer to our payer list to view the insurance companies for which electronic claim status is available. Eligibility Verification Patient eligibility verification is available in batch and real-time transactions. Please refer to our payer list to view the insurance companies that provide batch and real-time eligibility verification transactions.

2 Practice Name: Tax ID: Electronic Claims Submission Before completing this form, be sure that you have submitted a General Enrollment Form to HCIQ. Refer to the HCIQ Payer List to view e-commerce availability by insurance company. Check-off each type of claim file that you will be sending. For each file, please list the Payer IDs that you will be sending. For example, if you submit to Medicare in 2 states, please list the payer ID for each state. You do not need to list the payer IDs for the commercial claims. For each file, please indicate the file format that you will be sending. If you are unsure, leave this field blank, and your EDI testing coordinator will advise you once you test files have been analyzed. Claim Type HCIQ Payer ID(s) File Format Medicare Part B Medicaid Blue Cross Commercial N/A Please provide HCIQ with all of your practice s insurance company group numbers. Be sure to include Medicare and Blue Cross. HCIQ Payer ID Payer Name Group Number

3 HCIQ will require a test file for each of the types of files that you will be sending. An EDI Testing Coordinator will contact you regarding obtaining test files. Please submit this completed form via fax, or mail to HCIQ. Contact information is provided at the top of this page. Refer to the HCIQ Payer List to obtain any payer enrollment forms for Electronic Claims Submission that are required for the payers that you selected. Follow the instructions for completing each form. For your convenience, HealthCare IQ s information has been pre-filled in on all of the forms.

4 Electronic Remittance Statements Electronic Remittance Statements are only available for those insurance companies that provide electronic remittance statements (as listed on the HCIQ payer list). In addition, HCIQ must be your electronic claims submitter for each of the insurance companies for which you would like to receive electronic remittance statements. Please indicate the Payer ID and Payer Name for each insurance company for which you would like to receive electronic remittance statements. Payer ID Payer Name Please indicate the file format that you would like us to provide the electronic remittance statements in. If your billing system vendor has specific file format specifications or requirements, please forward them to your EDI Testing Coordinator for analysis. Please note: HCIQ provides standard 835 files as part of your e-commerce package. An additional charge may apply for custom programming to your vendor s specifications. Contact your sales representative for details. 835 HL7 Other (specify) Refer to the HCIQ Payer List to obtain any payer enrollment forms for Electronic Remittance Statements that are required for the payers that you selected. Follow the instructions for completing each form. For your convenience, HealthCare IQ s information has been pre-filled in on all of the forms.

5 Real-Time Transactions (Claim Status/Eligibility) All real-time transactions are available to electronic claims submission customers via the HCIQ message center. No additional enrollment information is required. Batch Eligibility Check here to enroll for batch eligibility transactions Your EDI Testing Coordinator will contact you with more information, including file format specifications.