Electronic claims
Oxford, a UnitedHealthcare company provider fact sheet
Enabling electronic claims submissions is a critical step
in our ongoing process to simplify and automate the
entire payment process. To achieve this goal, we have
made significant investments in technology to facilitate
the transmission and processing of electronic claims,
and have given these claims priority in reimbursement.
Why bill electronically?
• Faster claims turnaround time
• Lower outstanding receivables
• Claim tracking at the point of submission
• Fewer errors and fewer delays in processing time
• Multi-payer solution
• Overall reduction in administrative expenses
Who can submit electronic claims?
Enroll now at: post-n-track.com or call 1-800-257-2030.
The set-up process takes less than five minutes. Send
your next batch of claims directly to the payer with no
clearinghouse delays.
For more information about the benefits of EDI,
please contact the Provider e-Solutions Team at
1-800-599-4334, or via e-mail at
[email protected]
In order to submit your claims through your clearinghouse,
you will need to submit to our Payer ID Number: 06111.
When you begin submitting your claims electronically,
your clearinghouse will supply you with a tracking report
detailing your electronic activity. This report confirms
that your claims were received and lists any problems
encountered during your transmission. Concerns about
paper claims potentially lost in the mail are eliminated.
• All health care providers can submit electronic claims
— regardless of whether or not you participate with us.
• We accepts both CMS-1500 (medical) and UB04
(facility) claim formats electronically.
Less paper, less hassle...
more time for patient care.
How to submit electronic claims
You may submit claims electronically via your own
practice management software program linked to
a clearinghouse.
We accept electronic claims from the following
clearinghouses:
• AthenaHealth
• Emdeomtm
• ENS
• MedAvant
• MISYS
• RelayHealth (formerly NDCHealth, PerSe,
and McKesson)
• Transaction Methods, Inc.
Or through Post-N-Track®. Direct Connections for
Healthcare Claims via Post-N-Track is a simple, secure
and HIPAA-compliant solution offering you:
• Direct connectivity via the Internet
• No clearinghouses
• No cost to providers...no installation, transaction, or
support fees
• Easy to use
• Direct entry option available
Exceptions to electronic
claims submission
All types of claims can be submitted electronically,
except the following:
• Claims with Coordination of Benefits (COB); when
Oxford is the secondary carrier, copies of the primary
carrier’s Explanation of Benefits/Remittance Advice
are required
• Claims billed with unspecified CPT and/or HCPCS
codes; supporting documentation is required
• Resubmissions of previously processed claims
Providers submitting claims to delegated vendors
should continue to follow the delegated vendor’s
claims submission guidelines.
Provider e-Solutions team
#3. Provider daily statistics report
We have a dedicated team of professionals with an
in-depth understanding of the electronic solutions available
to meet your needs. They can also assist with a variety of
other questions related to EDI, including:
• Reading your tracking reports
• Summary of claims submitted
• Total dollar amount of the claim
• Number of claims accepted and rejected by
your clearinghouse
• Run date of the report
• Claim-by-claim summary of the rejections
• Does not include specific date of
service of the accepted claims
• Submitting electronic referrals
#4. Unprocessed claim report
• Hardware and software selection
For more information about the benefits of EDI, please
contact our Provider e-Solutions Team at 1-800-599-4334,
or via e-mail at [email protected].
• Notifies the provider when the payer cannot
process the claim
• Advises why the claim cannot be processed and
recommends that corrective action be taken
• Notifies the provider when a member ID number is
invalid or not eligible for the date of service submitted
• Benefits of electronic claims and EDI
• Problems with your vendor/software/clearinghouse
connections
Examples of claim submission
confirmation reports:
#1. Provider’s software report
• Includes detailed claim information
• Member information
• Line-by-line claim information
• Dates of service
• Services rendered
• Total amount of services rendered
• Date of submission to the clearinghouse
• Total amount of paper/EDI claims sent for the day
#2. Daily acceptance report by provider
• Lists claims accepted by your clearinghouse, which
were then passed on to the payer
• Includes the provider name, patient name and run
date of the claim
• Does not include a specific date of service for the
claim or total dollar amount of the claim
MS-04-1858 7415 R2
M44478-Q 1/09 © 2009 Oxford Health Plans, Inc.
Requirements for proof of
timely filing
• You must be able to show proof of claim submission
using the clearinghouse reports
• These EDI transmission reports must be specific and
must contain the following information:
• Name of insurance carrier that the claim was
submitted to
• Run date
• List of patient names
• Report showing all claims accepted and zero rejections
• #2 and #3
Claims submitted via a clearinghouse are audited
to determine that your claim is free of errors. The
clearinghouse will then forward your claims to the
insurance payer. If claim errors are detected, the
claim is returned to you with an explanation of the
error. You may then correct the error and resubmit
the claim. This process greatly reduces claim denials
and resubmissions.