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This Fact Sheet addresses some frequently asked questions about electronic claims submissions.
Q: WHAT PERCENTAGE OF CLAIMS SUBMITTED TO HNE ARE PROCESSED ELECTRONICALLY?
A: HNE electronically processes approximately 79% of the claims we receive.
Q: CAN ANY PROVIDER SUBMIT CLAIMS ELECTRONICALLY?
A: HNE encourages provider to submit electronic claims directly to us. For more information, please contact the Provider Relations Department at 413-787-4000 ext. 5000 or by e-mail to provider@hne.com.
HNE accepts claims electronically through the following clearinghouses:
- ClaimsNet: http://www.claimsnet.com/hne/ (or call 800-356-1511)
- Emdeon: http://www.emdeon.com/business_services.php/ (or call 800-845-6592) – NOTE: ACCEPTING CURRENT HNE PROVIDERS ONLY
- MedAvant: http://www.medavanthealth.com/ (or call 800-792-5256)
- The SSI Group: http://www.thessigroup.com/ (or call 800-881-2739)
- Xactimed: http://www.xactimed.com/ (or call 214-382-3535)
Your practice management system vendor also may submit claims to the above clearinghouses on your behalf.
Due to acquisitions and corporate restructuring, you may not recognize these names as a business with whom you already have a relationship. Check with your current vendor or clearinghouse to find out if they have a new name or are part of one of these businesses.
Q: DOES IT COST LESS TO SEND CLAIMS ELECTRONICALLY?
A: According to the Providers to whom we have spoken, “YES.” The cost to submit claims electronically is usually more than offset by lower costs for mailing, supplies, and personnel time.
For cost information specific to your practice, please contact your practice management system vendor or any of the above clearinghouses.
Q: WHAT IMPACT DOES ELECTRONIC CLAIMS SUBMISSION HAVE ON THE CLAIMS PAYMENT LAG?
A: Since electronic claims are processed faster than paper claims (on average in about 14 days less time) submitting claims electronically substantially reduces the claims payment lag.
Q: WHAT ELECTRONIC FILE FORMATS DOES HNE ACCEPT?
A: All claims submitted must be ANSI X12 837 compliant. ANSI refers to the American National Standards Institute (http://www.ansi.org).
Q: WHAT INFORMATION MUST APPEAR ON ALL ELECTRONIC CLAIMS?
A: For electronic submission, all claims submitted must be ANSI X12 837 compliant. Please reference the Claims Companion Guide for the specific requirements. (click here)
Q: CAN I STILL SUBMIT CLAIMS ELECTRONICALLY IF THEY REQUIRE SUPPORTING PAPER DOCUMENTATION?
A: Yes, HNE then will pend the electronic claim until our Claims Department receives the supporting documentation (e.g., invoices or operative notes).
Q: IF I SUBMIT CLAIMS ELECTRONICALLY, HOW DO I SUBMIT REFERRALS?
A: Using HNEDirect, you may submit referrals for in-plan elective outpatient services electronically through HNEDirect. This will expedite the processing of electronic claims.
Alternatively, you may fax paper referrals for in-plan specialty services to (413) 233-2630.
Q: IF I SUBMIT CLAIMS ELECTRONICALLY, CAN I RECEIVE AN ELECTRONIC EXPLANATION OF PAYMENT?
A: Yes, you may request an electronic Explanation of Payment. HNE can create the X12 835 Health Care Claims Payment/Advice using the HIPAA Implementation Guide. |
