For those interested in electronic claim filing, please contact your electronic data interchange (EDI) software vendor or one of the clearinghouses:

• Optum/Change Healthcare’s Provider Support Line, available via online chat or by calling 1-800-527-8133, option 2, Monday through Friday, 7 a.m. to 5:30 p.m. CST.
• Availity Client Services at 1-800-AVAILITY (282-4548). Assistance is available Monday through Friday from 8 a.m. to 8 p.m. ET. 
• Payer ID: 77741

If you do not have another clearinghouse/vendor, you can submit your claims electronically directly through Change Healthcare’s ConnectCenter or PCH Global.

Change Healthcare’s ConnectCenter

• Go to ConnectCenter and click the Sign Up under Get Started to create your new account. Use vendor code: 214629.
• Electronic claims will need to be submitted to Change Healthcare using four-digit ConnectCenter payer identifiers (CPIDs).
  • Institutional claims — 6649
  • Professional claims — 6751
• ConnectCenter will automatically edit and validate claims for HIPAA compliance and will forward them directly to the appropriate plan.
• If you need assistance, Change Healthcare customer support is available through online chat or by calling 1-800-527-8133, option 2.

PCH Global

• Go to PCH Global and click the Sign-Up link in the upper right-hand corner.
• Complete the registration process and log into your account.
• For a detailed walk-through of the registration process, refer to the PCH Global User Manual (PDF), found on the PCH Global website in the Resource Menu.
• When you are ready to submit claims, use the following payer information:
  • 77741
  • Keystone First VIP Choice

Promo code Exela-EDI may be available for use under the Subscription Details screen, by entering it under the More option, which can be found on the right-hand side.

Paper claims submission should be sent to:

Keystone First VIP Choice
Claims Processing Department
P.O. Box 7143
London, KY 40742-7143

Our plan accepts ANSI 5010 ASC X12 275 claim attachment transactions (unsolicited). Please contact your practice management system vendor or EDI clearinghouse to inform them that you wish to initiate electronic 275 claim attachment transaction submissions for payer ID 77741 via:

Availity

• There are two ways 275 claim attachments can be submitted:
  • Batch — You may either connect to Availity directly or submit attachments via your EDI clearinghouse.
  • Portal — Individual providers may also register at Availity Essentials multi-payer Portal to submit attachments.

After logging in, providers registered with Availity may access the Attachments — Training Demo for detailed instructions on the submission process via Training Link [at Availity] or refer to the Availity Claims Attachment Quick Reference guide located under Claims Resources of that page.

Optum/Change Healthcare

• There are two ways that 275 attachments can be submitted: 
  • Batch — You may either connect to Optum/Change Healthcare directly or submit attachments via your EDI clearinghouse.
  • API via JSON — You may submit an attachment for a single claim.

General guidelines

• A maximum of 10 attachments are allowed per submission. Each attachment cannot exceed 10 megabytes (MB) and total file size cannot exceed 100 MB.
• The acceptable supported formats are PDF, TIF, TIFF, JPEG, JPG, PNG, DOCX, RTF, DOC, and TXT.
• The 275 attachments must be submitted prior to the 837. After successfully submitting a 275 attachment, an attachment control number will be generated. The attachment control number must be submitted in the 837 transactions as follows:
  
  
  •  CMS 1500
    • Field Number 19
    • Loop 2300
    • PWK segment
  •  UB-04
    • Field Number 80
    • Loop 2300
    • PWK01 segment

In addition to the attachment control number, the following 275 claim attachment transaction report codes must be used when submitting an attachment. Enter the applicable code in field number 19 of the CMS 1500 or field number 80 of the UB04.

Electronic claim payment options

Our plan works with ECHO Health, Inc. (ECHO), a leading innovator in electronic payment solutions, to offer more electronic payment options to our health care providers. Providers can select the payment method that best suits their accounts receivable workflow.

Virtual credit card (VCC)

ECHO Health offers virtual credit cards as an optional payment method. Virtual credit cards are randomly generated, temporary credit card numbers that are either faxed or mailed to providers for claims reimbursement. VCC payments have several advantages for providers:

• No need to enroll or fill out multiple forms in order to receive VCC.
• Personal information, such as bank account information, is never requested.
• Payments are accessible the day the VCC is received.

Providers not registered to receive payments electronically will receive VCC payments as their default payment method, instead of paper checks. Your office will receive either faxed or mailed VCC payments, each containing a VCC with a number unique to that payment transaction, an instruction page for processing the payment, and a detailed explanation of payment/remittance advice (EOP/RA). 

Normal transaction fees apply based on your merchant acquirer relationship. If you do not wish to receive your claim payments through VCC, you can opt out by contacting ECHO Health at 1-888-492-5579.

Electronic funds transfers (EFT)

Electronic funds transfers allow you to receive your payments directly in the bank account you designate rather than receiving them by VCC or paper check. When you enroll in EFT, you will automatically receive electronic remittance advices (ERAs) for those payments. All generated ERAs and a detailed explanation of payment for each transaction will also be available on the ECHO provider portal.

If you are new to EFT, you will need to enroll with ECHO Health for EFT.

Please note: Payment will appear on your bank statement from PNC Bank and ECHO as “PNC — ECHO.”

Sign up to receive EFT from us. There is no fee for this service.

Sign up to receive EFT from all of your payers. A fee may be required to receive EFT if you select the all payers option.

If you already receive payments from ECHO Health, you may be able to enroll for EFT with our plan using your existing account. Please make sure you have an ECHO Health draft number and corresponding payment amount so your enrollment request can be validated.

A draft number is listed as the electronic processing code (EPC) draft number on ECHO Health's explanation of payments. If you need assistance locating an ECHO payment in order to register or if you have questions on how to enroll, contact ECHO at 1-800-946-4041, Monday through Friday, from 8 a.m. to 6 p.m. ET.

Electronic remittance advice (ERA)/835 file

Electronic remittance advices (ERAs) (often referred to as 835 files) are also available through ECHO Health. To receive ERAs from our plan, it is important to check with your practice management/hospital information system vendor to see if the system includes both the Keystone First VIP Choice payer ID 77741 and the ECHO Health payer ID 58379.

If you are not receiving any payer ERAs, please contact your current practice management or hospital information system vendor to ask if your software can process ERAs. Your software vendor is then responsible for contacting ECHO to enroll you for ERAs under our plan name and payer ID 77741 and the ECHO Health payer ID 58379.

If your software does not support ERAs or you continue to reconcile manually and you would like to start receiving ERAs only, please contact the ECHO Health enrollment team at 1-888-834-3511.

If you have additional questions regarding VCC, EFT, or ERAs, please call the ECHO Health support team at 1-888-492-5579.

Other claim information:

• Appropriate usage of claims modifiers 25 and 59 (PDF)
• CES explanation codes (PDF)
• Claim dispute form (PDF)
• Common errors for claims submissions (PDF)
• Reimbursement Policies
• Waiver of liability form for nonparticipating provider appeals (PDF)