EmblemHealth primarily offers providers two ways to receive claims payments:
· Electronic Funds Transfer (via Automated Clearinghouse (ACH)) with electronic remittance advice (EFT/ERA) (Registration required)
· Virtual Card (VCard) (Default payment method where no other election is in place)
Please contact ECHO Provider Support at 888-492-0032 if your practice cannot process EFT or VCard payments so an accommodation may be made for paper checks to be sent to your practice.
A major advantage of automated payments is the ability to receive an 835/ERA with each EFT payment. In addition, EFT payments will:
· Eliminate the need to handle payment processing at your practice
• Increase speed of receiving payments
• Significantly reduce payment processing costs
• Streamline the accounts receivable (A/R) process
• Reduce fraud exposure
• Improve the accuracy and timeliness of information
No registration is needed if you are currently registered with the PNC Remittance Advantage (RA) Program, or if you register with PNC RA at https://rad.pnc.com prior to Dec. 18, 2020. Your banking direct deposit information for EFT payment elections will automatically transfer to ECHO’s Claim Payments & Remittances (“CPR”) system.
If you have not enrolled for EFT payments prior to December 18, you may enroll after you receive your first CPR payment via ECHO Health VCard. You can enroll in EFT/ERA by contacting ECHO Provider Support at 888-492-0032 or enrolling online at: https://view.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. See example below showing where to find the EPC Draft number.
No. After the transition to ECHO, you will be able to view your 835/ERAs through the emblemhealth.com/provider portal.
No. For account security reasons, your current registration on PNC RA does not transfer to the ECHO system. Only your EFT banking selection will transfer. To register or create a new account as a first-time user and manage your EFT selection, you may enroll or modify your EFT information at https://view.echohealthinc.com/EFTERADirect/EmblemHealth/ or by contacting ECHO Provider Support at 888-492-0032.
To view 835s or ERAs directly through the ECHO system, you may establish a new account at providerpayments.com using your TIN and EPC Draft # or payment amount.
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.
Once the transition to ECHO is complete, emblemhealth.com/provider will have Explanations of Payment (EOPs) available for all claims. EOPs will be faxed along with VCard payments.
Electronic Remittance Advices Remittances (ERAs) will be sent to you through your clearinghouse and will be available for download from:
· rad.pnc.com – 835/ERAs processed through the Remittance Advantage Program (for payments made prior to January 1, 2021)
· providerpayments.com – 835/ERAs processed through CPR after January 1, 2021
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 do not participate in ECHO Health’s AllPayer service, then your payments will default to EFT if you have enrolled prior to December 18, 2020, or VCard if you have not enrolled.
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. The link is https://view.echohealthinc.com/EFTERADirect/EmblemHealth/
Your office will receive payment notifications via fax with an Explanation of Payment (EOP) along with a virtual card with a number unique to that payment transaction. If you do not have a HIPAA verified fax number on file at ECHO Health, the VCard and EOP will be mailed to your payment address on file in EmblemHealth’s claims processing system.
An instruction page is included with the notification. When you receive the ECHO Health VCard number, enter the code into your office’s credit card terminal to process payment as a regular card transaction. The steps for processing this payment are similar to how you accept and manually key-in patient credit or debit card payments today.
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 redeemed within 60 days, the vCard payment will be automatically voided and a paper check sent to your payment address.
Yes, after 60 days.
You may contact ECHO customer support at the contact information provided in the VCard instructions that are printed at the end of the EOP
There are no direct charges to you from EmblemHealth, PNC or ECHO for standard EFT/ERA, VCard 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 Vcard payments. Your healthcare clearinghouse may charge you fees to receive ERA data.
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.
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.
It can take up to ten business days for ECHO Health to validate a new bank account, so plan accordingly before closing your current bank account. Contact ECHO Provider Service at 888-834-3511 Monday through Friday from 8 a.m. to 6 p.m.
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 (3) business days of the EFT, please contact CPR Provider Service at 888-834-3511 Monday through Friday from 8 a.m. to 6 p.m.
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 Monday through Friday from 8 a.m. to 6 p.m.
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.