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For Medical Providers: Frequently Asked Questions About Claims Payment Processing By PNC/ECHO Health

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For Medical Providers: Frequently Asked Questions About Claims Payment Processing By PNC/ECHO Health

How will I be paid?

EmblemHealth primarily offers providers three ways to receive claims payments:

  • Electronic Funds Transfer (EFT)/Electronic Remittance Advice (ERA) - Registration required.
  • eCheck (MPX) – enrolled providers can download and print a check for deposit, eliminating postal delays.
  • VCard - Default method where no other election in place. No registration required for VCards (also known as virtual cards). No opt-in option for VCards.
    • Note: If the ECHO does not have a HIPAA verified fax on record, the VCard will be mailed. Providers may contact ECHO at 888 485-5073 to designate or change their FAX number.

Why should I sign up for automated electronic funds transfers (EFTs)?

What does CPR cost?

There are no direct charges to you from EmblemHealth, PNC, or ECHO for standard EFT/ERA, Virtual Cards, eCheck, or check payments, or for enrollment or portal services.  Your bank may charge you fees for receiving EFT payments or depositing checks. Your merchant acquirer may charge you fees for processing card payments. Your healthcare clearinghouse may charge you fees to receive ERA data.

What are the benefits of accepting Virtual Card (VCard) payments?

When faxed to a HIPAA compliant Fax machine, Virtual Card (also known as VCard) payments are not subject to mailing delays commonly associated with paper checks. Providers may contact ECHO at 888 485-5073 to designate or change their FAX number.

How do I register for EFT/ERA?

After you receive your first CPR payment via ECHO Health Virtual Card, you have the option to enroll in EFT/ERA by contacting ECHO Provider Support at 888-492-0032 or by visiting https://enrollments.echohealthinc.com/EFTERADirect/EmblemHealth.

Note:  In addition to your bank account information for the EFTs and your clearinghouse information for delivery of your 835/ERAs, you will need to provide your Tax ID Number (TIN), an ECHO check or “EPC Draft” number found on your remittance statement or recent payment amount as part of the enrollment authentication. 

Not Enrolled for ECHO EFT?

For EFT/ERA Enrollment and additional assistance regarding payment, contact ECHO Provider Support at 888-492-0032 or visit https://enrollments.echohealthinc.com/EFTERADirect/EmblemHealth.

How do Virtual Card payments work?

Your office will receive payment notifications via fax or mail and an instruction page will be included with the notification. When you receive the ECHO Health Virtual Card payment, enter the card number and CVV code into your office’s credit card terminal to process the payment as a regular card transaction. The steps for processing this payment are similar to how you manually key-in patient card payments today. 

How do I receive notification of Virtual Card Payment?

Your office will receive payment notifications via fax or mail with an Explanation of Payment (EOP) containing the Virtual Card with a number unique to that payment transaction. Providers may contact ECHO at 888-485-5073 to designate or change their FAX number.

How long do I have to process my Virtual Card?

If you have not retrieved your funds within 30 days, a reminder email (or postal mail, if email is not available) will be sent to you. If not processed within 60 days, the Virtual Card payment expires and will be voided. A paper check is then sent to your payment address.

If my credit card machine won’t process the Virtual Card, who do I contact for assistance?

You may contact ECHO customer support at the contact information provided below and within the Virtual Card instructions.

 

Virtual credit card processing

(888) 485-5073

Virtual credit card disenrollment/opt out

(888) 485-5073 or visit the self-service portal at www.echovcards.com.

Remove EFT enrollment

(888) 834-3511, Option 3

Who should enroll my practice online and become the Administrator?

The enrollee should be a person of authority in your practice, such as a Billing or Office

Manager. This person will be able to use and view all web functionality and set the security levels for other users. Please keep in mind that some viewable data contains PII (Personally identifiable information) and PHI (Protected Health information) so, you should follow your office’s HIPAA guidelines regarding access to information. It may be beneficial to select an additional person for Administrator access in case one person leaves your business. Please remember to cancel access for any individuals who leave your employment. 

How can I get a copy of my Explanation Of Payments (EOP) and 835/ERAs?

For EFT/ERA, you may obtain a copy of your EOPs and 835/ERAs for all claims through EmblemHealth’s provider portal. For Virtual Card payments, EOPs will be faxed along with card payments. ERAs will be sent to you through your designated clearinghouse and will be available for download from providerpayments.com.

I have set up payment preferences with ECHO Health for another payer. Do I need to do the same for EmblemHealth payments?

If you are enrolled in ECHO Health’s AllPayer service, then you do not need to take any action. Your payment elections will automatically be applied to your EmblemHealth payments and remittances.  If you are enrolled for EFT payments through ECHO for other payers, and do not subscribe to the AllPayer service, you  would need to enroll separately.

Do I need to change my banking relationship to receive EFT payments?

No change in your banking relationship is required. EFT payments leverage the Automated Clearing House (ACH) network used by all banks in the U.S., just like direct deposit of payroll. You may establish or modify the bank account to where future EFT payments are sent. 

Is CPR HIPAA-compliant?

Yes. HIPAA compliance covers three basic areas: security, privacy, and electronic transaction format. Security and privacy are addressed through proper security at sign-in and through: 

  • Auditing capabilities.
  • Strong encryption for all file transfers and data viewing.
  • Rules-based privileges for function and data access.

For transaction format compliance, CPR offers the option to receive the ERA in the HIPAA-compliant ANSI X12 835, version 5010 file format.

ECHO’s services comply with ERISA (Employee Retirement Income Security Act), HIPAA (Health Insurance Portability and Accountability Act), CORE (Committee on Operating Rules for Information Exchange), OFAC (Office of Foreign Assets Control), and Taft-Hartley regulations.

 

Does CPR provide data warehousing?

Yes. CPR provides online search and retrieval capabilities through the providerpayments.com web portal. With the first payment through CPR, all payment history is archived for 10 years. 

If my bank or bank account changes, how far in advance should I notify ECHO?

Resolving Late or Missing 835/ERA Transaction

CPR typically transfers funds (EFTs) and delivers the associated electronic remittance advice (835/ERA) within one banking day of each other. If you believe you have not received an 835/ERA within three business days of the EFT, please contact CPR Provider Service at 888-834-3511 Option 2, Monday through Friday from 8 a.m. to 6 p.m.

Resolving Late or Missing EFT Transactions

CPR typically transfers funds (EFTs) and delivers the associated electronic remittance advice (835/ERA) within one banking day of each other. If you believe you have not received an EFT within three (3) business days of the 835/ERA, please contact CPR Provider Service at 888-834-3511 Option 3, Monday through Friday from 8 a.m. to 6 p.m. 

What is an electronic remittance advice (835/ERA)?

An 835/ERA is a computer transaction that contains the detail associated with one or more claim payment transactions. It replaces the paper Explanation of Payment (EOP). It includes the amount of payment, the method of funds delivery (e.g., check, electronic funds transfer, card), and other claim details. 835/ERAs are available sooner than paper remittance advices and can be viewed, downloaded, printed, or imported directly into your A/R system.

835/ERAs also report adjusted and denied claims processed, including situations where the net payment is zero. Any denied claim will be reported along with a denial or reason code with descriptions.

I have questions about my 1099

If you wish to obtain your 1099 or have questions regarding information on your 1099 that was produced by ECHO, you may contact 888-834-3511 Option 3.

Additional Helpful Information

If you have questions about this process, please sign in to the provider portal at emblemhealth.com/providerportal and use our live agent chat or Message Center to contact us. A Provider Customer Service Representative will be happy to help.