Affinity utilizes these Payer ID Numbers:
Medicare Advantage and Medicaid Advantage claims.
For all Medicaid, Child Health Plus, and Essential Plan claims.
For all AffinityAccess (Qualified Health Plan) claims
Behavioral Health claims. You will also need to include Affinity’s plan ID of
There are several direct and recognizable
benefits to submitting claims electronically:
Customer Service at 1-866-247-5678 or email us at email@example.com.
Currently, Affinity does not offer direct data entry for claims and only
accepts claims filed electronically via our partner clearinghouse,
If you are already sending
claims through Emdeon for other payers, you do not need to contact them, just
begin submitting Affinity claims electronically, following the guidelines
identified in EDI
If you are NOT currently submitting claims through
Emdeon for other payers, you or your billing vendor will need to establish a
connection for electronic submission with them. You can contact Emdeon directly
at 1-877-469-3263 for instructions and guidelines.
Affinity will accept 837P and 837I transactions
through the Emdeon clearinghouse. If you are unable to submit claims in any of
the accepted formats identified in the 837P and 837I
Companion Guides, please contact your billing system vendor.
You should routinely review and load to your
practice management system the confirmation and rejection reports supplied by
your vendor and Emdeon each time you transmit to Affinity. These reports should
be used to compare your actual submission totals against the totals shown on the
reports. They will confirm which claims have reached their destination and which
claims were rejected. If you do not currently receive these reports or you are
unsure how to use them, please contact your vendor.
Regardless of your
individual vendor, when you send a claim electronically to Affinity, it must be
processed through Emdeon. At Emdeon, the claim goes through a set of standard
edits to make sure the claim is error free. If the claim meets these standard
requirements, Emdeon accepts the claim and forwards it to Affinity. If the claim
is missing required information or does not meet Emdeon's edits, Emdeon rejects
the claim and the claim does not reach Affinity.
The following are
Emdeon Reports that you should check to see if your claims were passed to them.
They are listed by a report code. The report code can be found in the upper
left-hand corner of your report. If your claims are filed electronically to an
intermediary vendor first and then passed to Emdeon, please check with your
vendor to ensure you are receiving comparable reports.
This report lists the totals of claims
submitted, accepted, and rejected by Emdeon for all payers for that day.
Accepted claims are forwarded on to the payers, rejected claims are not
forwarded. Any rejected batches or claims are listed on this report including
the reason they were rejected. These claims can then be corrected and
re-submitted to Emdeon.
summary lists number of accepted claims per batch. It also contains a Provider
Totals section that shows all input, accepted, and rejected statistics for that
day, month-to-date, and year-to-date.
This report lists the claims accepted by Emdeon and forwarded to all
This summary contains
the Month-To-Date and Year-To-Date claim totals and statistics for
This problem could result from
several different areas. Please review the items below to determine the most
If all of the above have been
checked and verified and Affinity is still not receiving your claims, please
contact Customer Service at 1-866-247-5678 or email us at: firstname.lastname@example.org.
offer a service that automatically converts electronic claims to paper if they
are rejected during transmission to the next vendor (usually the Emdeon
clearinghouse). Review your Emdeon rejection reports and contact your vendor to
discuss how they handle rejected claims.
No. Please choose either
paper or electronic filing, never both. Filing twice, by paper and electronic,
will result in duplicated claim handling by Affinity.
Yes. Affinity Health Plan processes claims
and encounters through the same system. It is important to submit claims and/or
encounters for all services rendered. Affinity will continue to include these
claims in the remittance advice with a message the service is covered under a
an ERA/EFT solution with our partner clearinghouse, Emdeon, for our Medicaid,
Family Health Plus, and Child Health Plus product lines only. Please contact
Emdeon directly to enroll at http://www.emdeon.com/epayment/ or 866-506-2830.
You will need to contact Emdeon directly even you use another clearinghouse
besides Emdeon. The process is fast and simple and EFTs will start within the
next 7 to 10 days following enrollment. It should be noted that you will
continue to receive paper EOPs as well as your 835 ERA for a period of 45 days
following enrollment so plan accordingly to be sure you can accept and load your