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Healthcare Claim​ Remittance Advice (835) and Payment

 

Electronic Remittance Advice (ERA or 835) details payment information on claims. The ERA, available through Electronic Data Transmission Interchange (EDI) transaction 835, is more efficient than waiting for a paper remittance advice. Most software systems can use an 835 to automatically post payments to the proper accounts.
 
Electronic Funds Transfer (EFT) deposits funds for SelectHealth claim payments directly into your bank account. In order to receive the EFT, you must also be able to accept the 835.
 
Process to Receive the 835 and/or EFT
You can receive an ERA (835) with payment through electronic funds transfer (EFT) or you can still receive a paper check.
  • If you would like to receive the 835 but would like to continue to receive your payments as paper checks, please fill out the form below and select the form type “835.”
  • If you would like to receive the 835 and EFT payments, complete and download the form below.
 
Electronic Remittance Advice (835) and/or Electronic Funds Transfer (EFT)
 
·         Choose form type “835” to receive paper payment checks with your electronic remittance advice.
·         Choose form type “EFT” to receive electronic funds transfer with your electronic remittance advice.​ 
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Electronic Remittance

Provider Information

Provider Identifiers Information

ex: 555-555-5555

ex: 555-555-5555

Electronic Remittance Advice Clearinghouse Information

ex: 555-555-5555

Banking Information

You authorize SelectHealth to initiate credit entries to the selected accounts.

Please attach an original, voided check or letter from your financial instituion on the instituion’s letterhead. Do not use a checking deposit slip for EFT deposits. Checking deposit slips do not always contain the necessary routing and transit information.

It is the applicant’s responsibility to ensure that the information provided on this form is complete and accurate. SelectHealth will not be responsible and shall be held harmless for errors made in EFT payments that are a result of inaccurate or incomplete information provided on this form. In no event and under no circumstances will the liability of SelectHealth exceed the amount of the EFT payments in question. Failure to complete any part of this agreement will delay your conversion to EFT.

By submitting this document, you agree that your typed name is your binding electronic signature. The date and time that the document is signed will be stored within the system.

ex: 555-555-5555

Upon request, we will send a paper remittance advice as well as an 835 for the first 31 days so that you can receive remittances appropriately. You may need to contact your clearinghouse to make sure they send responses to you. Once that transition period has lapsed, the remittance advice will only be sent electronically; no paper remittances will be sent. 

 

Delivery of Remittance Advices and Payments

Each week, remittance advices and payments are sent as follows:

 

Remittance Advice/Payment

Monday

Tuesday

Wednesday

Thursday

Friday

Medical 835

X

 

 

X

 

Dental 835

 

 

X

 

 

Medical EFT

 

X

 

 

X

Dental EFT

 

 

 

X


Medical paper remits

 

 

X

 

 X

Medical paper checks

 

 

X

 

 X

Dental paper remits

 

X

 

 

 

Dental paper checks

 

X

 

 

 

 

 

Late/Missing EFT or ERA (835) Resolutions Procedure

Contact your software vendor or clearinghouse to make sure they know to send the information to you. If you have not enrolled directly through them, they may receive the ERAs but not have known where to forward them or whom to notify. Contacts for missing EFT payments or 835 remittance advice are:

  • If you are missing an EFT payment, please contact our Finance Team at 801-442-4686, option #1.
  • If you are missing an 835 remittance advice, please email our EDI Team or call 800-538-5099.

 

Mailing an EFT/ERA Request

If you would prefer to print and mail the EFT request, please download our EFT form and follow the instructions on the form.

 

If you are a pharmacy and trying to locate the pharmacy-only EFT form, please contact the Pharmacy Helpdesk at 801-442-4912.

 

Questions? Please contact the SelectHealth EDI Team via:

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