• Claims

  • Claims Submission

    For inquiries on submitting EDI claims, send an email to your Provider Relations Representative. You may also access Affinity payer-specific information via the Emdeon clearinghouse website at www.emdeon.com.

    Submitting Claims Electronically

    For efficient and quick processing of your claims, Affinity recommends that you submit your claims via electronic data interchange (EDI). If you are already submitting claims electronically to Affinity, you may want to reference our 837P and 837I Companion Guides and other EDI information. If you need help, please contact your Provider Relations Representative or check the provider manual.

    For more information on claims submission:

    Review our EDI frequently asked questions (FAQs) For inquiries on the process for submitting EDI claims through Emdeon, our clearinghouse, you may access the Emdeon website at www.emdeon.com.

    Submitting Paper Claims by Mail

    You may download these paper claim forms: CMS-1500 (Professional) and UB04 (Institutional). These forms are also available through various vendors, the American Medical Association (AMA) or the U.S. Government Printing Office.

    Addresses for paper claims:

    For Child Health Plus and Medicaid Members
    Affinity Health Plan
    P.O. Box 981726
    El Paso, TX 79998 - 1726

    For Affinity Medicare Members
    (Services rendered in 2018)
    P.O. Box 4018
    Scranton, PA 18505-6018

    Effective January 1, 2019, Medicare membership transitioned to EmblemHealth. Affinity will continue to provide customer service and pay claims for services rendered in 2018. However, for 2019 claims, providers MUST contact EmblemHealth:
    via EDI: Payer ID 55247
    or
    via mail: EmblemHealth
    P. O. Box 2845
    New York, NY 10116 - 2845

    Submission Guidelines

    In order to most efficiently and accurately process your claims, please review the following guidelines.

    DO:

    • Submit only original CMS1500/UB04 claim forms.
    • Align all characters in their proper sections and designated fields.
    • Type or machine-print all mandated claim fields.
    • Make sure all of the mandatory fields are completed and legible.
    • Submit clean claims forms without smudges or discolorations.
    • If using carbon forms, send only the original or top copy.
    • Make sure the information entered on the claim form is readable. Claims that are too light may be returned.
    • Submit only six line items per claim.
    • If you make request for a claim review, please submit in a separate letter and not on the claim form.

    DON'T:

    • Make handwritten corrections;
    • Use red ink;
    • Squeeze two lines of information on one line;
    • Place extra writing across item 24;
    • Place Post-it notes or stapled notes on the form;
    • Use hand stamps;
    • Use highlighters;
    • Use special characters, dollar signs, decimals, dashes or other symbols.

    Reimbursement Forms

    Sterilization Consent Form
    To receive reimbursement for sterilization procedures, please fax completed form and associated claim(s), according to Affinity guidelines, to Affinity’s Medical Management Pre-Certification Department at 718.794.7822 or 718.536.3329.

    Acknowledgement of Receipt of Hysterectomy Information Form
    To receive reimbursement for hysterectomy procedures, please fax completed form and associated claim(s), according to Affinity guidelines, to Affinity’s Medical Management Pre-Certification Department at 718.794.7822 or 718.536.3329.

    You may also access these forms from the New York State Department of Health's website at health.state.ny.us/health_care/.

    Electronic services

    Affinity Health Plan now supports 835 remittance processing through Emdeon Payment Services.