Claims Processing

Ease of claim submission, online tools that have real-time claim status and member eligibility, support for EDI Claim and Eligibility status, and quick and accurate claim processing are some of the first benefits you will experience with PHCS Savility. Most importantly, Payers accessing the PHCS Savility network contractually agree to strict claim processing and turnaround requirements designed to get you paid faster.

 

 

 

Member Eligibility

Checking member eligibility is just a mouse click away. The PHCS Savility Portal features an Eligibility Inquiry section that makes eligibility look-up fast and easy. Eligibility files are updated daily to ensure that your claims will be processed quickly and accurately.

 

PHCS Savility also supports Eligibility Question and Response 270/271 EDI Transactions. Just as with claim status, simply submit the request using the PHCS Savility Payer ID and receive automated eligibility response.

 

Submitting Claims

PHCS Savility makes submitting claims easier. Regardless of whom the payer is, all claims are submitted to a single electronic payer ID (if submitting electronically) or to a single PO Box (if submitting paper claims).

 

You can submit claims electronically through your existing claims clearinghouse, or if you prefer you can submit them directly to InstaMed via clearinghouse or EDI. In addition, you can submit claims manually through the PHCS Savility Portal.

 

Electronic Claims Submission to a Claims Clearinghouse

MultiPlan is contracting with multiple electronic clearinghouses to support PHCS Savility claim submission. The clearinghouses we’ve approached all have very broad reciprocal agreements with regional electronic clearinghouses as well. Simply confirm with your clearinghouse that they support electronic payer ID [13306]. If not, contact PHCS Savility Provider Service and we can have Instamed investigate a reciprocal with the clearinghouse to request they be added to the list.

 

Claim Repricing

Upon receipt of a claim from a PHCS Savility provider, MultiPlan checks member eligibility, applies the PHCS Savility discount when appropriate and transmits the repriced claim to the payer.  PHCS Savility clients then apply benefit plan design (claim processing) to the claims and return them to PHCS Savility for prompt payment. PHCS Savility Payers agree to initiate claims payment/remittance each day for all claims ready to be paid.

 

Claim Processing

Upon receipt of a repriced PHCS Savility claim from MultiPlan, clients adjudicate and process the claims for payment within strict timelines required to meet the following contractually agreed payment turnaround times:

  • UB claims - 90% of all electronically submitted clean UB claims are paid within 10 calendar days.

  • HCFA claims - 90% of all electronically submitted claims are paid within 15 calendar days.

  • All claims - 95% of all electronically submitted claims are disposed within 15 calendar days.

 

Adjusted Claims

In addition to our strict requirements for initial claim payment the PHCS Savility product also requires that a minimum of 95% of all agreed upon claim adjustments are paid within five business days from the date of issue resolution.

 

Misdirected and Returned Claims

As noted above, one important change that comes with PHCS Savility is that claims are directed to a single electronic payer ID or PO Box across all PHCS Savility Payers. It's important that providers send claims directly to a PHCS Savility electronic payer ID or PO Box, and not to the payer, as indicated on the back of PHCS Savility member ID cards.

 

To assist our PHCS Savility providers we will be tracking misdirected claims with our Payers and will reach out to you if we identify a trend in misdirected claims.

 

Checking on Claim Status

You can check the status of the claims you have submitted by going to the Claims Status Inquiry section of the PHCS Savility Portal. The PHCS Savility Portal gives real-time status of all claims and gives claim detail including:

  • Current Status, Current Location

  • Amount Paid by Plan

  • Member Responsibility

  • Check Date/Electronic ACH Date

  • Check/ACH Transaction Number

 

PHCS Savility also supports Claim Status Question and Response 276/277 EDI Transactions. Simply submit the request using the PHCS Savility Payer ID and receive automated eligibility response.

 

 

 

 

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