EI Billing Providers:

As EI Billing Providers have been enrolling to receive 835 remittance (also called Electronic Remittance Advice, or ERA) from third-party payers, PCG would like to remind providers about some key benefits of enrolling to receive 835 remittance now:

1.  835 is the New Standard: The SFA and BEI consider 835 to be the new standard for EI Billing Providers to receive electronic remittance information. Providers should (but are not required to) begin the enrollment process as soon as they receive enrollment forms.

2.  Benefits to Providers: There are several benefits to providers that enroll to receive 835 remittance:

a.      Shorter Payment Cycle – Receiving remittance data electronically shortens the lifecycle of a claim, by allowing the SFA to receive remittance data more quickly

b.      Reduction in Administrative Burden – Reduces manual work by eliminating the need for EI Providers to enter remittance data directly into EI Billing or send remittance data to the SFA for processing

c.      Data Accuracy and Completeness – Allows the SFA to receive more detailed information, which stands up to scrutiny and protects the Provider

d.      Reduction in Denials – Helps prevent subsequent denials based on untimely claims resubmissions

e.      Industry Standard – The receipt of insurance remittance data via an 835 is a HIPAA-compliant industry standard practice

3.  EOB Entry Shut-off: Following enrollment in the 835 process, BEI will be ending manual entry of EOBs for all EI Billing Providers. The SFA can work to guide you through this transition as seamlessly as possible, so that all EI Billing Providers can begin enjoying the multitude of benefits offered by the 835 process. (Note: EI Billing Providers that do NOT enroll to receive 835s prior to EOB manual entry shut off must wait for flat files to return before the claims can move to the next payer.)

EI Billing Providers that have enrolled to receive 835 remittance have already begun to see benefits. In one specific example, the payer GHI received a claim file from NYEIS on January 27^th. Providers that had enrolled to receive 835 remittance from GHI were sent an 835 just two days later, on January 29^th. Conversely, providers that receive remittance from GHI via flat files may have to wait up to one month, as GHI processes flat files on a monthly basis. Providers can view their payment posting history in EI Billing to see how long it takes for their payments to post. For the majority of payment activity, providers will notice a shorter payment cycle for 835 remittance compared other payment posting methods.

If you would like more information about the benefits of receiving 835 remittance, or have any questions about the enrollment process, please contact the PCG Customer Service Center at (866) 315-3747.

Article ID: 312, Created On: 2/19/2016, Modified: 2/19/2016