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WellPoint, Oxford, Aetna and Fidelis Remittance Success – More than 66% of Remittance Data Now Collected Electronically

 Dear Colleague: 

Effective today, Early Intervention (EI) billing providers no longer have to enter Explanation of Benefits (EOB) remittance data into the EIBilling system for WellPoint, Oxford, Aetna and Fidelis. PCG, the State Fiscal Agent (SFA), working with the Department of Health (DOH), Department of Financial Services (DFS) and these four insurers, has created, tested and implemented a system of receiving, loading and reporting remittance data for claims made by EI billing providers for children covered by WellPoint, Oxford, Aetna and Fidelis. This will improve the ability of providers to receive timely payments and reduce manual data entry by providers.

Currently, the SFA is receiving electronic remittance files from the following insurers, which represents more than 66% of remittance for EI services. This represents $30 Million in billed claims processed by the insurers in the chart below from April 1, 2013 through February 28, 2014.

Insurers Name                      Percentage of  Total Remittance Data

WellPoint                                                        12%
Oxford                                                            10%
Aetna                                                                7%
Cigna                                                                6%
Fidelis                                                               3%
Excellus                                                            6%
MVP                                                                  2%

DOH, DFS, and SFA continue to work with other insurers to obtain, review and load remittance data. PCG is currently receiving and reviewing remittance files from other major insurers including, Affinity, Independent Health and Hudson Health which totals 3.4% of remittance data. The SFA will provide updates on the completion of those remittance processes as they occur.

WellPoint, Oxford, Aetna and Fidelis have now built the capabilities to generate and send the remit file to the SFA on a routine basis and the SFA is ready to accept and post these files when received.

EI billing providers will be able to review the remittance data for claims for services to children covered by these insurers on  Although not recommended, to avoid duplicate data, providers will have the ability to continue to enter remittance information for these insurers from paper EOBs via for a limited time.

The SFA also wishes to remind providers that they no longer have to enter EOB remittance data themselves into The SFA is providing manual entry of this data to providers who wish to take advantage of this service. For more information about how to take advantage of this service, please click here.

Should EI billing providers have questions WellPoint, Oxford, Aetna and Fidelis remittance data on EIBilling, they should contact the PCG Customer Services Center at 1-866-315-37

Please do not reply to this e-mail announcement.

Thank You.

Article ID: 146, Created On: 3/26/2014, Modified: 10/28/2015

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