Medical Provider Newsletter - October 2020

Duplicate claim facts

Before you resubmit a claim because you have not received your payment or a response regarding your payment, consider this:

  • When you resubmit the same services, we must conduct additional investigative steps, which lengthens the claim processing time.
  • The member will receive multiple EOBs for the same service, often resulting in a confused call to your office.
  • The majority of claims submitted to EMI Health are processed within 30 days (98.9 percent so far this year).
  • In fact, the average medical claim is processed within six days.

Before resubmitting a claim

The next time you do not receive a response from your original claim, please take the following steps prior to submitting a duplicate claim:

  • If the original claim was submitted electronically, check your response report to verify that the claim was accepted. If accepted, wait 30 days from the date you submitted the claim before contacting EMI Health's provider assist team to verify status and next steps.
  • If the original claim was submitted on paper, wait 30 days from the date you submitted the claim, then contact our provider assist team to verify receipt and next steps. You may also log into your My EMI Health account to see if the claim has been posted yet.

Duplicate claim coding

If you do resubmit a claim for any reason, please indicate that fact on the claim form. The CMS 1500 or electronic equivalent requires a "D" in field 10d. The UB 04 or electronic equivalent requires a "7" as the type of bill code in the third position in field 4.

Thank you

We appreciate the service you provide to our members and recognize the importance of your time. Our goal is to process all claims as quickly and efficiently as possible. Please help us reach that goal by avoiding unnecessary duplicate claim submissions.