Providers FAQS
- What is the billing process?
- What information is required on my claim?
- How will it be paid?
- What portion is the insured responsible for paying?
- What if I disagree with the way my claim is paid?
- Which providers and facilities may I refer my patients to?
Q: What is the billing process?
A: To avoid claim processing delays, each billing must be completed with all the required information (please see below). We prefer that you send your claims through Electronic Data Interchange (EDI). To send claims electronically, you must preregister by contacting the EDI Specialist at 1-801-262-7476 or 1-800-662-5850 toll free. Upon completion of registration you will receive a unique EMI Health submitting provider number that will allow you to process our claims electronically.
Q: What information is required on my claim?
A: Please refer to the CMS 1500 and UB92 standards for information regarding what is required on your form. If you are not using EDI, your office staff must use the CMS-1500 universal claim forms. EMI Health will not accept super bills.
Q: How will it be paid?
A: The claim will be paid according to the policyholder's contract and the EMI Health Table of Allowance. EMI Health uses the Viant fee schedule for its Beech Street providers.
Q: What portion is the insured responsible for paying?
A: The insured pays the difference between the allowable charge and the amount EMI Health pays. If the provider is participating, any balance in excess of the EMI Health Table of Allowance will be adjusted by the provider. This amount will be outlined on your explanation of payment, under the "Insured Pays" column.
Q: What if I disagree with the way my claim is paid?
A: You may request a review of any adverse claim decision by following the claims review procedure.
Q: Which providers and facilities may I refer my patients to?
A: EMI Health's insureds will receive maximum benefits, with less out-of-pocket expense when they are referred to participating providers. For those plans using the Beech Street network, please remember to refer EMI Health insureds to Beech Street participating facilities and specialists. You may access the most up-to-date provider listing on our website.
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