Public Consulting Group (PCG), as the State Fiscal Agent
(SFA) receives and processes remittance information for claims billed to
commercial insurance. The SFA receives remittance data electronically from
several insurance carriers (see below for a list of carriers). Explanation of
Benefits (EOB) are also entered manually by either PCG or the provider.
In order to control the flow of remittance data entry, PCG
would be glad to manually enter EOBs for providers. Providers can send EOBs via
secure fax line directly to PCG (for more information on how to do this, see this
Knowledge Base article). As part of our entry process, PCG checks first to
see if the insurer has already entered remittance data electronically. This
allows us to ensure that there is no duplication of data entered into the
system. Note: If a provider has previously opted-out of the PCG entry option,
they may opt back in at any time by sending an email to nyeibilling@pcgus.com.
Providers can also manually enter their own EOBs. Step-by-step
instructions for manually entering EOBs through EIBilling.com can be found in this Knowledge
Base article. Please keep in mind when entering EOBs that remittance data
may have already been entered electronically by the insurance carrier.
PCG is currently receiving electronic remittance from the
insurance carriers listed below. Depending on the carrier, PCG receives
remittance data on a weekly, bi-weekly, or monthly basis. These 15 plans
represent over 90 percent of the total number of commercial insurance claims
processed in EI Billing.
|
Aetna
|
Affinity
|
Amerigroup
|
CDPHP
|
Cigna
|
|
Emblem
|
Excellus
|
Fidelis
|
Healthnow
|
Hudson
|
|
Independent
|
MVP
|
Oxford
|
UHC
|
Wellpoint
|
A good resource for remittance information is the new
Insurance Remittance Data Report available on EIBilling.com. This report offers
new and enhanced functionality for providers, including greater search
capability for specific remittance data, and more efficient sorting and
exporting of relevant data. The tutorial for this report can be accessed
here: Insurance Remittance Data.
If you have any
questions, please contact the PCG Customer Services Center at (866) 315-3747.
Article ID: 178, Created On: 7/17/2014, Modified: 10/28/2015