Claims, Billing, and Payment
Billing Manual and Provider Guides
- Billing Manual (PDF)
- FQHC Billing Guidance
- Claims and Billing FAQ
- Electronic Submission Methods for CCH, Partners, and Trillium (PDF)
- Tailored Plan Billing with Partners and Trillium for Physical Health Providers (PDF)
- Provider Taxonomy Guide (PDF)
- Provider Guide: Claim Corrections, Reconsiderations, and Grievances (PDF)
- Claims Guide- Timely Filing (PDF)
- EPSDT Claims and Authorizations (PDF)
- Provider FAQ- Pended Claims Requiring Additional Information (PDF)
- Claims Guide- Duplicate Submissions (PDF)
- Pediatric Provider Billing Guidance (PDF)
- Claims Submission Reminder Guide (PDF)
- Provider Guide for 340B Drug Claims (PDF)
- Guidance for Submitting CLIA Claims (PDF)
- Coordination of Benefits Walkthrough (PDF)
- 835 EDI Companion Guide (PDF)
- 837 EDI Companion Guide (PDF)
- 2022 AMA Coding Guidelines for Social Determinants of Health (PDF)
Electronic Funds Transfer (EFT)
- Payspan is an innovative web-based solution for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). By using Payspan, you can speed up the processing and payment of your claims.
- Note: In November of 2022, Zelis, a company modernizing the business of healthcare, completed the acquisition of Payspan. Providers should continue using the Payspan payment portal: login or register.
- Payspan: A Faster, Easier Way to Get Paid (PDF)
- To contact Payspan: Call 1-877-331-7154, Option 1 – Monday thru Friday 8:00 am to 8:00 pm est.
Provider Claims Schedule
Claim Type | Claims Schedule |
---|---|
Medical | Monday, Wednesday and Friday (Effective 7/28/25). Payment issued to providers the following business day. |
Envolve Vision | Weekly, Wednesday |
NIA | Weekly, Tuesday and Friday |
Pharmacy | Weekly, Wednesday |
Definitions
- Paid in Full - The claim has been adjudicated, processed and reimbursed in accordance and with the executed provider contract on file including the coordination of benefits, as applicable per claim.