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2014 Emdeon Clearing House Setup and Enrollment Forms

Attention EI Billing Providers
Emdeon Clearing House Setup and Enrollment Forms

Audience: Current Early Intervention (EI) Billing Providers who Bill Third Party Insurers

In an effort to streamline the billing process to third-party insurers and improve payment turnaround to providers, Public Consulting Group (PCG) the State Fiscal Agent (SFA) is working with the Emdeon Claims Clearinghouse to increase the amount of billing that can be done electronically. By submitting claims electronically, the SFA is able to check claim status and adjudicate claims faster for providers. Additionally, submitting your claims electronically with a claims clearinghouse will allow the SFA to fix technical issues found on claims that in the past would have required the billing provider to reenter claims into EIBilling or NYEIS.

Although the SFA currently submits the majority of your claims electronically through Emdeon, there are some smaller payers as well as Blue Cross Blue Shield, which require authorization by the provider to submit electronic claims.

In order to obtain authorization from providers to submit claims, the SFA is sending billing providers a number of prefilled forms that the billing provider must complete, sign and return to PCG via U.S. mail. Please check to make sure that the information the SFA has inserted into the form(s) is correct. 

The forms can also be accessed here: Emdeon Enrollment Forms. If you need assistance, please contact the PCG Customer Services Center at 1-866-315-3747, which can help you obtain pre-populated forms from the Billing and Claiming Team.

The forms contain language that is standard in the healthcare industry to setup trading partner agreements. The purpose of the agreements are to make sure that all parties are working together to comply with all state and federal laws and ensure all transactions are compliant. Providers must complete these forms in order for the SFA to process payment electronically.

Once they have reviewed the form(s), they must sign and return them via U.S. mail to Public Consulting Group 200 International Dr., Suite 201, Portsmouth, NH 03801

The completed documents should be returned to the address above by June 2, 2014. 

If a billing providers has questions or concerns about the forms, or if there is information on the forms that need to be corrected, they can contact PCG Billing Operations team at

Article ID: 157, Created On: 5/7/2014, Modified: 10/27/2015

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