Payment information

We issue weekly remittance advices and corresponding payments, if applicable, to all health care providers for processed claims. Even if your patient assigns benefits to you by signing an authorization, you will still receive direct payment for the services rendered, unless the patient submits the claim personally, in which case payment will be made directly to them.

For each claim listed on the remittance advice, a corresponding Explanation of Benefits (EOB) notice is sent to the member, detailing the balance they are responsible for paying.

To receive electronic remittance advices (835 ERA) in ANSI format, enroll through Availity Essentials by following these steps:

1. Go to My Providers
2. Select Enrollments Center
3. Click on Transaction Enrollment

You can also access and manage your remittance advices online through Availity Essentials. You have the following options:

• View individual claims within a remittance advice
• Download a readable PDF of the entire remittance advice
• Download a PDF of a single claim within a remittance advice

To access these features, navigate to Availity Essentials: Claims & Payments > Remittance Viewer.

Remittance advices provide detailed information on how we processed your claims, including:

• Line-by-line breakdowns for most claims, with the exception of some institutional claims that are reported at the claim level.
• Specific codes that explain the processing outcome for each service or claim, including: Claim Adjustment Group Codes (CAGC), Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC). These codes provide detailed information on the processing outcome and indicate who is liable for any adjustments or balances.
• Provider Adjustments, which outline any overpayments that need to be recovered or are currently being recovered.

View our message codes for additional information about how we processed a claim.

Members can use their Health Savings Account (HSA) funds to make payments to providers for qualified medical expenses. Many of our members who have an HSA as their chosen health plan product use HealthEquity, one of the largest Health Savings Account (HSA) non-bank custodians.

HealthEquity offers the following payment options::

• Reimbursing members directly for any out-of-pocket expenses they incurred once the claim is processed
• Providing a debit card that the member can use to pay for expenses from their HSA account

• Paying the provider directly through the HealthEquity virtual card payment process, once the claim has been processed

If a member chooses the virtual card payment process, the provider will receive a payment voucher via fax. If HealthEquity does not have the provider's fax number, they will mail the initial payment voucher to the address indicated on the claim and will then work with the provider to set up the faxing option for future use. The voucher indicates the member's account information and the payment amount with instructions for how to obtain the payment using a merchant terminal.

The virtual card option benefits include faster payment delivery and funds availability, no trips to the financial institution to make deposits, plus better fraud protection. Contact HealthEquity Customer Service at (866) 919-0537 with any payment questions.

If you disagree with a decision regarding reimbursement, care management, or medical or dental policy, resubmit the claim with additional clarifying information, such as history and physical, operative report or narrative of unusual considerations that support the medical necessity of the service. If the determination is not reversed in this claims review or if you disagree with the subsequent determination, you may wish to use the appeals process.

Regence receives an administrative fee for each HealthEquity Integrated HSA. The fee allows for a high level of support and integration between Regence's health plans and HealthEquity health savings accounts.