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Eligibility and Claims

Electronic Claims Processing

Would you like to:

  • Decrease administrative costs?
  • Avoid processing delays?
  • Increase your claim acceptance rates?
  • Increase productivity?
  • Receive records of claim receipts?
  • Receive detailed claims status?

You can have speed, convenience and lower administrative costs through Electronic Data Interchange (EDI), or electronic claims processing. Health Partners Plans utilizes the Emdeon Transaction Services, also known as NEIC, ENVOY, or WebMD ENVOY claims clearinghouse.

How to take advantage of this service

  • Contact your billing software vendor and request that your Health Partners, KidzPartners or Health Partners Medicare claims be submitted through the Emdeon claims clearinghouse, or
  • Direct your current EDI clearinghouse to forward your claims to Emdeon.

For all claims (CMS-1500/837P and UB-04/837I) submitted electronically through the Emdeon clearinghouse, Health Partners Plans can electronically return a detailed status for each claim. The status message will show which claims were accepted, rejected and/or pending, and provide the amount paid on the submitted claim once it has been finalized.

If you are an Emdeon submitter and you do not have the ability to receive Emdeon claims status, please contact your billing software vendor for more information.

For more information

  • Read our EDI FAQs
  • Submit your question(s) via e-mail using the EDI Inquiry Form
  • Call our Provider Helpline at 215-991-4350 or 1-888-991-9023