Claims and Payment Information and Resources
YOUR CLAIMS AND REMITTANCES
At VNSNY CHOICE we understand that easy filing and timely payment of claims are a high priority for our providers. Although you may submit paper claims by mail, there are many benefits to submitting claims electronically, such as improved accuracy, reliability, convenience, and expedited payments.
Claims must be received within 90 days of the date or services (or the time frame stipulated in your contract). If VNSNY CHOICE is not the member’s primary insurance, please submit the claim within 90 days of the date on the Explanation of Payment from the primary carrier
PLEASE NOTE: As of March 27, 2020, all Claim Disputes must be submitted through VNSNY CHOICE’s Provider Claim Dispute Form. Disputes that are not sent through our Provider Claim Dispute Form will not be addressed. If you are unsure whether to submit a Claim Dispute or Claim Appeal, please click “Should I Submit a Claim Dispute or Claim Appeal” below.
| ELECTRONIC PAYMENT FOR PROVIDERS |
| It’s easy to further expedite your claims payments by signing up for electronic funds transfer (EFT) payments that are direct deposited into your bank account. You don’t have to wait for our checks to arrive in the mail or manually sort, reconcile, and deposit checks. Plus, our ePayment provider, Change Healthcare, offers an online application that allows you to search, view, and print human-readable images of your remittances. You will need to complete both of the following two steps in order to begin receiving EFT payments and remittances: 1. To set up EFT payments, fill out this VNSNY CHOICE EFT Request Form and hit the “Send” button. 2. To receive ERA files, enroll with Change Healthcare directly. For more information, please contact a Provider Services Representative at 1-866-783-0222 or e-mail us. |
Claims Resources
Consult these additional resources for answers to your questions about claim forms, remittances, billing codes, and the transition from ICD-9 codes to ICD-10 codes.
If you have any questions or require further assistance, please fill out our Contact Us form or call Provider Services at 1-866-783-0222, Monday – Friday, 8 am ‐ 5 pm.
For step-by-step instructions on how to sign up for electronic claim submissions, please click on this link for the Emdeon Enrollment Guide. Enroll today. You’ll be able to switch from paper to electronic submissions by filling in some simple information.
Once you are registered, additional information for all our providers about how to submit claims can be found for all our providers in Section 9 of our Provider Manual.
For electronic submissions:
Use VNSNY CHOICE Payer ID# 77073.
For hard copy (paper) submissions:
VNSNY CHOICE Claims
P.O. Box 4498
Scranton, PA 18505
Or call us at:
1-866-783-0222
(TTY: 711)
Monday – Friday, 8 am – 5 pm
Covered Part D vaccine claims should be mailed to:
MedImpact Healthcare Systems
P.O. Box 509108
San Diego, CA 92150-9108
Check our Required Data for Claims Forms below for sample forms and a list of required data elements, MLTC provider billing instructions for MLTC and nursing home providers, and provider codes for Adult Day Care, Chore Services, and Home Delivered Meals providers.
It’s easy to check on the status of a claim you’ve submitted by signing into the Provider Portal.
For information on how to use the Provider Portal, including how to verify member eligibility, please view this Provider Portal User’s Guide (PDF).
For a line-by-line guide to VNSNY CHOICE Remittance Forms, please view our Provider Remittance Fact Sheet.
When to use the Provider Claim Dispute Form:
- Coding denials
- Underpaid/overpaid claims
- Invalid procedure code/revenue code/diagnosis code
- Incorrect modifier
- Denied for authorization and provider has authorization letter
You can also consult Section 9 of our Provider Manual to review the list of requirements needed for filing a dispute.
When to submit a Claim Appeal:
If your claim is denied and you wish to challenge the decision, you can use the Grievance and Appeal Process. This will lead to an internal clinical or administrative review of the denial.
Examples of appealable denials include:
- Services not authorized
- Not medically necessary
- Non-covered service
- Non-covered benefit
- Benefit exhausted
- Charges previously considered
Please click here for complete instructions for submitting a Provider Claim Dispute.
- When submitting a disputed claim, you must include an excel attachment. Download this template and use it to enter the information listed in each column. We’ll need it in order to process your payment dispute. (Note: if you don’t see the template right away, check your browser’s download status bar or the download file on your computer.)
- Attach the file in the field labeled “File upload” when you submit your dispute using this Claim Dispute Form.
- Look for an email confirmation of your submission.
You can also consult Section 9 of our Provider Manual to review the list of requirements needed to filing a dispute.
If you want to file an appeal, the request must be submitted in writing, via fax or mail.
Please send your request by fax to 1-866-791-2213.
Or by mail to:
VNSNY CHOICE Health Plans
Attn: Grievances & Appeals
P.O. Box 445
Elmsford, NY 10523
Consult Section 9 of our Provider Manual to review the list of requirements and time frames needed for filing an appeal.
Claim Appeals: Notification of a decision will be made within 60 calendar days of receiving the appeal. If you are an out-of-network provider filing a claim appeal, a decision may take up to 120 days if a completed Waiver of Liability form is needed. No extension may be taken on payment appeals and payment appeals cannot be processed as “fast” appeals.
The CMS-1500 claim form (sample) and UB-04 claim form (sample) can be used to bill fee-for-service encounters. The UB-04 form should be used by facilities and by facilities billing on behalf of employed providers.
Please be sure your claim has these required data elements before submitting your form. This information is needed for claims to be processed correctly.
You can find instructions for submitting your claim by clicking on How to Submit Claims, above.
In-network providers should follow these billing procedures when submitting claims to VNSNY CHOICE.
These are the most frequently asked questions about the transition from ICD–9 codes to ICD-10 codes and how it affects in-network providers for VNSNY CHOICE.
VNSNY CHOICE has selected Change Healthcare as its electronic payment and remittance reporting provider. There is no cost to you to use Change Healthcare ePayment and enrollment is free.
Learn more about Change Healthcare ePayment. You can also find the steps you’ll need to follow to begin receiving payments and remittances on our Electronic Payment for Providers page.
For a line-by-line guide to VNSNY CHOICE Remittance Forms, please view our Provider Remittance Fact Sheet.
Check these Billing Instructions for Nursing Home Providers for information about billing and claims procedures.