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Claims and e-transactions for providers

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Simplify your claims process with our comprehensive provider tools. From electronic claims submissions to payment options and appeals, find everything you need including the CRRF and support from our dedicated provider care team.

Provider payment options

Claim payment cards

  • Similar to credit/debit cards and subject to existing merchant processing rates
  • Replacement for paper check payments

EFT/ERA (835 transactions)

  • No fee
  • Payments directly deposited into your bank account

Register online or contact InstaMed:

EDI claims submission

For claims submission to AllScripts, Availity® or Experian, use GHP Payer ID #75273.

For more information, contact:

Claims reconsideration process

Online claim review request

  • If you are a NaviNet capable provider, you’ll need to visit navinet.net and use the Claims Appeals function under Workflows for this Plan/Claims.

Paper claim research request form

  • Use the paper claim research request form (CRRF) to avoid unnecessary delays in processing. 
  • CRRF and necessary accompanying documentation must be submitted within 60 days from the date of the Explanation of Payment (EOP). 
    • Any request submitted without required supportive documentation or submitted after 60 days from the date of the EOP will have the original denial upheld. 
  • Check off the applicable reason for the reconsideration request and include the name and telephone number of the person completing the form.
  • For timely filing, submission must include proof of timeliness. Timely filing does not exist for Coordination of Benefits claims. Submit EOP electronically.
  • Claim reconsiderations submitted using the CRRF will be finalized within 45 days of receipt. Participating provider will be notified of GHP’s determination with a new EOP with an explanation code and/or letter.
  • Mail CRRFs to the following address:
    Claims Department
    Geisinger Health Plan
    P.O. Box 160
    Glen Burnie, MD 21060 

CRRF tips

  • For a quicker response, use the online claims appeals function on NaviNet.
  • If you’re unable to use NaviNet, use the claim research request form to avoid unnecessary delays in processing. 
  • Only submit 1 claim per CRRF form.
  • Include claim number and date of service on the form.
  • Check the appropriate boxes (i.e., COB or Claim Edit).
  • Do not submit replacement and voided claims using the CRRF process. 
    • Submit replacement claims as you would a new claim. The original claim is considered null and void and is completely replaced by the information on the replacement claim submission. Any payments made on the original claim will be retracted. Consider payments made on your replacement claim as payment in full. If the replacement claim has been denied, your original payment will not be reinstated.
  • Explanation of Benefits from the primary claim can be submitted with the initial electronic claim filing.
  • Coordination of Benefit (COB) claims are not subject to timely filing.
  • GHP has 45 days to review and process CRRFs.
  • Do not submit duplicates.
  • For corrected claims filed outside of timely filing, send a CRRF.
    • If within timely filing guidelines, submit electronically.

When to use a CRRF

  • Authorization denials (failure to precertify 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 in a timely manner. 

When a CRRF is not necessary

  • For electronic capable providers: Submit claim retractions as a complete void/cancel claim using frequency code 8 for full voids/retractions.
  • If an electronic provider: Submit correct claims electronically.
  • Questions related to provider contracts or fee schedules? Call the provider engagement team at 800-876-5357.
  • Timely filing denials – if no compelling reason exists. 
  • Authorization denials – if no compelling reason exists.
  • Tomorrow Health denials. 
 

Resolve a claim issue

GHP's provider care team is here to answer your claim questions quickly and correctly.

  • Call 844-GHP-PROV (844-447-7768) and say "claims" to connect with a dedicated claims resolution representative.

Companion documents for provider-submitted electronic claims

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EDI help desk

All fields are required unless marked optional

Provider support

Other provider support

Access links for Availity®, NaviNet®, InstaMed®, pharmacy support, case management and more