Claims Process
We believe your claims process experience should be as painless as possible. Online claims processing saves both time and paper. Read below for step-by-step instructions on how to enroll in the program, submit claims electronically, and more.
How to Enroll Your Office for Online Claims
1. Complete both of the following forms:
2. Include a voided check from the bank account in which you wish to deposit Healthfirst's electronic payments.
3. Submit these documents to Healthfirst Provider Services in one of these three ways:
- By fax: 1-646-313-4635
- By mail to:
Healthfirst Provider Services
P.O. Box 5168
New York, NY 10274-5168
- Give your completed paperwork to your Healthfirst Network Management representative.
Once You Are Enrolled
Your Healthfirst Network Management representative will notify you of the effective date for your first electronic transmittal once your paperwork has been processed. Electronic payments will be made each Friday after a claim has been processed.
You will continue to receive an Explanation of Payment (EOP) for a 60-day grace period. After the grace period, you will only receive the Electronic Remittance Advice (ERA). Bank statements will continue to reflect deposited amounts and dates of deposit. See below for more information on ERAs.
For more on claims, see Section 16: Provider Compensation of the Provider Manual.
> View the claims software note
Submission
Claims must be filed within 180 days** of the date of service. You may submit either electronic or paper claims. Providers should submit paper claims to:
Healthfirst Claims
P.O. Box 958438
Lake Mary, FL 32795
**Timely filing for all out-of-network (OON) Medicare claims is one (1) calendar year.
Healthfirst encourages providers to file online claims and accepts both institutional and professional claims this way. Electronic filings are submitted through the Electronic Data Interchange (EDI) utilizing the Emdeon claims clearinghouse (formerly Web-MD).
Providers who don't have claims submission software may sign up for a free online account with MD Online to begin filing electronically. Once on the MD Online site, click on Claims Submission under Provider Services to register.
Information That Must Be Included With Each Electronic Claim
1) Valid National Provider Identifier (NPI) residing in the appropriate system.
Where should my NPI reside?
- 837 Professional (HCFA) - Loop 2310B Rendering Provider Secondary ID, Segment/Element NM109. NM108 must qualify with an XX (NPI).
- 837 Institutional (UB04) - Loop 2010AA Billing Provider, Segment/Element NM109. NM108 must qualify with an XX (NPI).
> Download 837 Professional Companion Guide
> Download 837 Institutional Companion Guide
2) Healthfirst Payer ID Number: 80141
Basic Requirements for Online Claims
Contact your software vendor and request that your Healthfirst claims be submitted through the Emdeon clearinghouse. Or have your current clearinghouse forward your claims to Emdeon.
Reimbursement & Reconciliation
The Electronic Funds Transfer (EFT)/ Electronic Remittance Advice (ERA) program offers convenient services that enable direct deposit and automated documentation of Healthfirst claim payments.
With EFT, reimbursements are wired directly into your account. This means no lost checks, no deposit slips to prepare, and no waiting for checks to clear.
ERA is your digital Explanation of Benefits, an electronic statement that reduces your paperwork and allows you to easily reconcile reimbursements to your patient accounts.
Basic Requirements for EFT/ERA
- A bank account in which to deposit the electronic funds (checking account preferred).
- Your office must submit claims electronically*.
- An account with Emdeon, the clearinghouse Healthfirst uses to process claims. Healthfirst will work with any clearinghouse you may have.
- Your clearinghouse/software vendor must be able to accept the ERA file in the 835 HIPAA standard format.
*Still submitting paper claims? Sign up for a free on line account with MD Online.
Additional Resources
| Claims Inquiry Express Request Guide |
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| Assistance for Medicare Retro-Disenrollment Notices |
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| List of Claim Modifiers |
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| Submission FAQ |
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| Reimbursement FAQ |
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