Now Available: Electronic Commercial Coordination of Benefits – Electronic Claims Transactions

Date Issued: 8/25/2015

We are pleased to announce that EmblemHealth has begun accepting electronically submitted claims for payment as a secondary insurance carrier. The HIPAA ASC X12N 837 transaction applies to services rendered by health care professionals, including 837P for medical practitioners, 837D for dental practitioners and 837I for facilities and hospitals in which payment responsibility is apportioned between the primary insurance carrier and a second carrier. This enhancement of electronic claims processing was not previously available to our provider community.

Our ability to accept Coordination of Benefit (COB) claims electronically improves the overall processing of claims payments. Electronic COB claims will:

  1. Allow for prompt review and payment
  2. Ensure fewer claims are denied for missing COB information
  3. Reduce human error
  4. Be available to HMO and PPO providers at all levels of technological readiness

EmblemHealth recognizes the importance of accurate claims payment to your practice and works diligently to upgrade our claims processing procedures. Correct submission of electronic claims to EmblemHealth will also ensure we can process your claims more quickly and accurately. Commercial COB electronic claims that do not meet the requirements set forth in the 5010 Implementation Guide or are submitted without the necessary information about the other payer may be rejected for missing, incomplete or invalid information.

Submitting Electronic Claims

For those medical professionals still submitting paper claims, we recommend you investigate electronic claims submissions. EmblemHealth has information available to assist in the transition from paper to electronic claims. If you are interested, we suggest you review EDI Transactions, What to Know to Make Them Work For You for information on how to set up electronic billing. If you would prefer to use a billing service or a claims clearinghouse, EmblemHealth has resources to help you choose. And finally, EmblemHealth has engaged PNC Remittance Advantage to provide electronic funds transfers and electronic remittance advices to further streamline your billing and accounts receivables procedures.