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Claims Submission

 

Instead of submitting claims by mail, consider the advantages of submitting them electronically or through your Practice Management Software (PMS). You can send claims electronically through an Electronic Data Interchange (EDI) claims transaction. Electronic claims are typically more accurate and allow us to reimburse you more quickly. And EDI is more than just claims—you can also receive remittance advice, eligibility, and claim status.


EDI Transactions

Electronic Data Interchange (EDI) transactions provide an efficient and secure way to send and receive information. EDI transactions are sent via a secure connection through the Utah Health Information Network (UHIN). Rather than sending claims through the U.S. Postal Service or taking the time to call Member Services, EDI X-12 transactions deliver results within seconds. Additionally, you can request batch information for most payers. This means, for payers that participate with UHIN, you can receive benefits and eligibility information on all of your next day’s scheduled appointments in one transaction, regardless of who the payer is. Review the following transactions to see how EDI can make your practice more efficient.

837 – Claims Submission

Submitting claims via an 837 transaction allows for faster and more accurate claims adjudication and payment.  Utilize the eCOB segments in the 837 claims transaction to significantly speed up the processing time of a COB claim.

999 – Claims Submission Acknowledgement

This acknowledgement provides an initial acceptance or reject status for a batch of submitted claims. If a common mistake is detected in a batch submission, such as an invalid ZIP code, the entire batch of claims will be rejected. Check your 999 report every time you submit claims electronically to ensure your claims were received and are progressing through adjudication.

277CA – Individual Claim Acknowledgement

This transaction provides information regarding the accept/reject statuses of individual claims based on SelectHealth® internal requirements.  If an error is reported on a claim through a 277CA report, you can correct the inaccurate data and resubmit it without waiting to receive a formal denial notice.

835 – Electronic Remittance Advice

The Electronic Remittance Advice (ERA) transaction details claim payment information.  If your practice management software allows, the 835 can be used to auto post payments and is faster and more efficient than a paper remittance advice. 

Note: Providers using the 835 have the option to receive electronic payments through Electronic Funds Transfer (EFT).  This is a secure direct deposit of payment funds to a specified bank account in a timely manner.

 

270/271 – Eligibility and Benefit Inquiry/Response

Providers can submit a 270 Eligibility and Benefit Inquiry listing multiple scheduled patients, regardless of payer. A 271 Response will be returned within minutes showing complete eligibility, benefits, COB, and accumulation information for every payer participating with UHIN. This saves practices from having to make phone calls to individual payers regarding each patient on their schedule.

276/277 – Claim Status Request and Response

Submit a 276 request to check on the status of a specific claim. The 277 response informs you of where the claim is in process, and if final, provides payment information. Batch and individual submission can be queried using the 276/277 transaction

To initiate participation on any EDI transaction with SelectHealth, call the SelectHealth EDI team at 800-538-50995442. Find more information on the EDI section of our website. You’ll also find enrollment forms for ERA and EFT as well as companion guides for 270/271 and 276/277 transactions.

Manual Transactions

Providers can submit paper claims on a CMS 1500 form (version V02.12) for medical professional services or a UB-04 form for hospital/facility billing.  Billing requirements for SelectHealth Advantage® can be found at cms.gov. Claims should be mailed to:

               SelectHealth Advantage

               P.O. Box 30196

               Salt Lake City, UT 84130-0196


Claims Filing Deadlines

All claims for services rendered must be submitted electronically or on paper within 12 months of the date of service.

Claims received by SelectHealth more than 12 months after the date of service will be denied unless the provider can show that notice was given or proof of loss was filed as soon as reasonably possible.

When SelectHealth is the secondary payer, Coordination of Benefits (COB) payments, will be made only if the information supporting the payment is submitted to SelectHealth within 12 months after the claim was processed by the primary plan, unless the provider shows that the information was supplied or proof of loss was filed as soon as reasonably possible.

 

For more information about electronic submission, contact our EDI team: 

Electronic Data Interchange (EDI) 
800-538-5099
edi@selecthealth.org
selecthealthphysician.org/edi

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