Claims and e-transactions for providers
Learn more about submitting claims and receiving payments.
Electronic fund transfer (EFT) and electronic explanation of payment (835 transaction)
GHP has replaced paper check payments with claim payment cards. Claim payment cards are processed like any other credit/debit card payment you receive through the mail or by phone and are subject to existing merchant processing rates. To avoid receiving claim payment cards, you can register for free EFT/ERA transactions from GHP. To receive GHP payments directly deposited into your bank account and/or to begin receiving electronic remittance advice/835, register at www.instamed.com/eraeft or complete the InstaMed Network Funding Agreement and fax or mail to InstaMed.
EDI claims submission
Use the GHP Payer ID Number (75272) when submitting claims via AllScripts, Emdeon, or Relay Health. Contact the following for more information:
Claims research request form (CRRF)
To ensure efficient and timely reconsideration of claim payment/denial appeals, utilize the CRRF to initiate a reconsideration of a previously paid or denied claim. Make copies of the blank form as necessary and retain a copy of the completed forms for your records – or submit electronically via NaviNet.
- CRRF may be submitted electronically online through NaviNet
- Only submit one claim per CRRF form
- Include claim number and date of service
- Check the appropriate COB or Claim Edit boxes
- GHP has 45 days to review and process CRRFs
When to use a CRRF
- UA denials (failure to precert services) – only when there is a compelling reason why the provider failed to precert, and the dispute is within timely filing guidelines
- Claim edit denials – Be sure to check the claim edit box on the CRRF form and attach supporting documentation.
- Timely filing denials – only when there is a compelling reason for why the provider failed to submit timely
- When information on a paid claim needs to be corrected (e.g., late charges, incorrect diagnosis, incorrect procedure code, incorrect revenue code, incorrect modifier, invalid Member ID, location code)
When NOT to use a CRRF
- Non-participating provider
- Claim retractions – providers should initiate through Customer Service on secured message via Web
- When information on a denied claim needs to be corrected, providers should resubmit the corrected claim through their normal claims submission process.
- P2 or XX denials – questions related to provider contracts or fee schedules should be directed to your provider account manager.
- Timely filing denials if no compelling reason exists. COB claims are not subject to timely filing.
- UA denials – if no compelling reason exists
Learn more about Geisinger Health Plan.