For Medical Providers: Frequently Asked Questions About Claims Payment Processing By PNC/ECHO Health

EmblemHealth primarily offer providers two ways to receive claims payments:

  • Electronic Funds Transfer (EFT)/Electronic Remittance Advice (ERA) - Registration required.
  • VCard - Default method where no other election in place. No registration required for VCards (also known as virtual cards). No opt-in option for VCards.
    • Note: If the ECHO does not have a HIPAA verified fax on record, the VCard will be mailed. Providers may contact ECHO at 888 485-5073 to designate or change their FAX number.

There are no direct charges to you from EmblemHealth, PNC or ECHO for standard EFT/ERA, VCard or check payments, or for enrollment or portal services. Your bank may charge you fees for receiving EFT payments or depositing checks. Your merchant acquirer may charge you fees for processing card payments. Your healthcare clearinghouse may charge you fees to receive ERA data.

When faxed to a HIPAA compliant Fax machine, virtual card payments are not subject to mailing delays commonly associated with paper checks

No registration is needed if you were registered with ECHO or with the PNC Remittance Advantage Program (prior to Aug. 15, 2020). Your EFT payment elections will automatically transfer to ECHO’s Claim Payments & Remittances (“CPR”) system. However, if you are not registered, please contact ECHO Provider Support at 888-492-0032 to set up payment preferences or if your practice cannot process EFT or VCard payments.

After you receive your first CPR payment via ECHO Health VCard, you have the option to enroll in EFT/ERA by contacting ECHO Provider Support at 888-492-0032 or enrolling online.

Note:  In addition to your bank account information for the EFTs and your clearinghouse information for delivery of your 835/ERAs, you will need to provide your Tax ID Number (TIN), an ECHO check or “EPC Draft” number found on your remittance statement or recent payment amount as part of the enrollment authentication. See example below showing where to find the EPC Draft number. 

For EFT/ERA Enrollment and additional assistance regarding payment, you can contact the ECHO EFT Enrollment Hotline at 888-834-3511.

Your office will receive payment notifications via fax and an instruction page will be included with the notification. When you receive the ECHO Health VCard number, enter the code into your office’s credit card terminal to process payment as a regular card transaction. The steps for processing this payment are similar to how you manually key-in patient card payments today. 

Your office will receive payment notifications via fax with an Explanation of Payment (EOP) along with a virtual card with a number unique to that payment transaction. 

If you have not retrieved your funds within 30 days, a reminder email (or postal mail, if email is not available) will be sent to you. If not processed within 60 days, the VCard payment expires and will be voided. A paper check is then sent to your payment address.

You may contact ECHO customer support at the contact information provided below and within the VCard instructions.

 

Virtual credit card processing

(888) 485-5073

Virtual credit card disenrollment

(877) 260-3681

Provider opt-out of Vcard or remove EFT enrollment

CPR Customer Service at 833-629-9725

Yes. Since your EFT direct deposit selection has transitioned to ECHO, you will be able to view your 835/ERAs through the providerpayments.com portal hosted by ECHO. You can view EOPs at either the ECHO provider portal or the EmblemHealth’s provider portal. emblemhealth.com/provider portal.

The enrollee should be a person of authority in your practice, such as a Billing or Office

Manager. This person will be able to use and view all web functionality and set the security levels for other users. Please keep in mind that some viewable data contains PII (Personally identifiable information) and PHI (Protected Health information) so, you should follow your office’s HIPAA guidelines regarding access to information. It may be beneficial to select an additional person for Administrator access in case one person leaves your business. Please remember to cancel access for any individuals who leave your employment. 

For EFT/ERA, you may obtain a copy of your EOPs and 835/ERAs for all claims through EmblemHealth’s provider portal. For VCard payments, EOPs will be faxed along with VCard payments. ERAs will be sent to you through your clearinghouse and will be available for download from:

  • PNC.com – 835/ERAs processed through the Remittance Advantage Program (for payments made prior to transition)
  • providerpayments.com – 835/ERAs processed through CPR

If you are enrolled in ECHO Health’s AllPayer service, then you do not need to take any action. Your payment elections will automatically be applied to your EmblemHealth payments and remittances.  If you are enrolled for EFT payments through ECHO for other payers, and do not subscribe to the AllPayer service, you  would need to enroll separately.

No change in your banking relationship is required. EFT payments leverage the Automated Clearing House (ACH) network used by all banks in the U.S., just like direct deposit of payroll. You may establish or modify the bank account to where future EFT payments are sent. 

EmblemHealth’s transition from PNC RA to ECHO spans from Aug 19, 2020 to Sept. 2, 2020. In addition, we are in the final stages of migrating our lines of business to newer technology. During this time, you could receive payments from multiple sources. Over the next few weeks you will see all payments eventually process from ECHO. If you believe you have received incorrect payments, please contact our Provider Customer Service center at 866-447-9717.

Yes. HIPAA compliance covers three basic areas: security, privacy, and electronic transaction format. Security and privacy are addressed through proper security at sign-in and through: 

  • Auditing capabilities.
  • Strong encryption for all file transfers and data viewing.
  • Rules-based privileges for function and data access.

For transaction format compliance, CPR offers the option to receive the ERA in the HIPAA-compliant ANSI X12 835, version 5010 file format.

ECHO’s services comply with ERISA (Employee Retirement Income Security Act), HIPAA (Health Insurance Portability and Accountability Act), CORE (Committee on Operating Rules for Information Exchange), OFAC (Office of Foreign Assets Control), and Taft-Hartley regulations.

 

Yes. CPR provides online search and retrieval capabilities through the providerpayments.com web portal. With the first payment through CPR, all payment history is archived for 10 years. 

CPR typically transfers funds (EFTs) and delivers the associated electronic remittance advice (835/ERA) within one banking day of each other. If you believe you have not received an 835/ERA within three business days of the EFT, please contact CPR Provider Service at 888-834-3511 Monday through Friday from 8 a.m. to 6 p.m.

CPR typically transfers funds (EFTs) and delivers the associated electronic remittance advice (835/ERA) within one banking day of each other. If you believe you have not received an EFT within three (3) business days of the 835/ERA, please contact CPR Provider Service at 888-834-3511 Monday through Friday from 8 a.m. to 6 p.m. 

An 835/ERA is a computer transaction that contains the detail associated with one or more claim payment transactions. It replaces the paper Explanation of Payment (EOP). It includes the amount of payment, the method of funds delivery (e.g., check, electronic funds transfer, card), and other claim details. 835/ERAs are available sooner than paper remittance advices and can be viewed, downloaded, printed, or imported directly into your A/R system.

835/ERAs also report adjusted and denied claims processed, including situations where the net payment is zero. Any denied claim will be reported along with a denial or reason code with descriptions.

If you wish to obtain your 1099 or have questions regarding information on your 1099 that was produced by ECHO, you may contact 440-835-3511

You can always contact EmblemHealth Provider Services to escalate your concerns. We can be reached at 866-274-0060.

     

Date(s)

Membership

Website for EOPs & 835s

Claims payments after 10/1/19

Bridge (HIPIC & GHI) (ASO members)

EFT, VCards, & Checks:  providerpayments.com

Claims payments prior to 8/18/20

GHI members 

EFT:  rad.pnc.com

Checks:  emblemhealth.com

Claims payments on or after 8/19/20

GHI members

EFT, VCards, & Checks:  providerpayments.com

Claims payments prior to 9/2/20

HIP & HIPIC members

EFT: rad.pnc.com

Checks:  emblemhealth.com

Claims payments on or after 9/2/20

HIP & HIPIC members

EFT, VCards, & Checks:  providerpayments.com

Upon plan renewal effective date 

GHI members whose plans have not renewed in 2020 yet (member IDs that do not start with “K”)

EFT:  rad.pnc.com

Checks:  emblemhealth.com