SFA Receipt of 835 Electronic Remittance Data from Emdeon

PCG, as the State Fiscal Agent (SFA), has identified a process that will streamline the receipt of electronic insurance remittance data for certain Early Intervention (EI) providers. PCG will be reaching out to providers that meet the criteria stated below to initiate this process.

The new process will allow payers to electronically send insurance remittance data in a HIPAA-compliant 835 format (835s) via Emdeon to the SFA. Emdeon provides a claims clearinghouse that allows the SFA to increase the amount of billing that can be done electronically. We believe that this will create a more streamlined, effective process, both for the SFA and providers. Benefits of the SFA receiving 835s from Emdeon include:

• Allowing the SFA to receive remittance data more quickly
• Enabling providers to quickly find out if their claim has been denied and take action
• Reducing the volume of remittance data that is currently being posted manually
• Improving the accuracy of remittance posting
• Facilitating the life cycle of a claim by moving non-workable denied claims, and partially paid claims, to the next payer more promptly

To confirm that you or your organization would like to have the SFA receive your 835s from Emdeon, please send an email NYSFAEIP@pcgus.com, using the subject line “835 Electronic Remittance.”

After confirmation, PCG will provide – via secure email – information on this new process for receipt of electronic insurance remittance data. This will include the forms and instructions necessary to sign up to allow the SFA to receive 835s from Emdeon.

If you have any questions about this new submission process, or if you have trouble accessing the secure email, please contact the PCG Customer Service Center at (866) 315-3747.