Frequently Asked Questions
- What is the billing process?
- What information is required on my claim?
- How will my claim be paid?
- What portion is the insured responsible for paying?
- What if I disagree with the way my claim is paid?
- To which providers and facilities may I refer my patients?
What is the billing process?
Answer: We prefer that you send your claims through Electronic Data Interchange (EDI). EDI claims have a faster processing time than paper claims, and there is a reduced chance of error. If you are not yet set up to send claims through EDI, you will need to obtain a trading partner number from Utah Health Information Network (UHIN). Once you've received that number, you may begin submitting EDI claims to EMI Health's trading partner number HT000214-001. Test claims are not required. EMI Health also works with all of the major clearinghouses. If you have questions, call our Provider Assist Line at 801-262-7975 or toll free at 800-644-5411.
What information is required on my claim?
Answer: Please refer to the ADA or CMS standards for information regarding what is required on your form. If you are not using EDI, your office staff must use the most current ADA, CMS-1500, or UB92 universal claim forms. EMI Health will not accept super bills.
How will my claim be paid?
Answer: The claim will be paid according to the policyholder's contract and the EMI Health Maximum Allowable Charge.
What portion is the insured responsible for paying?
Answer: The insured pays the difference between the allowable charge and the amount EMI Health pays. If the provider is participating, any balance in excess of the EMI Health Maximum Allowable Charge will be adjusted by the provider. This amount will be outlined on your explanation of payment, under the "Insured Pays" column.
What if I disagree with the way my claim is paid?
Answer: You may request a review of any adverse claim decision by following the claims review procedure.
To which providers and facilities may I refer my patients?
Answer: EMI Health's insureds will receive maximum benefits, with less out-of-pocket expense when they are referred to participating facilities and specialists. You may access the most up-to-date provider listing here. EMI Health does not cover non-accredited facilities.