Claims Explanation of Payment/835 Remittance Advice and Reimbursement

You can receive your 835 remittance advice (RA) weekly by electronic batch transaction with remittance information auto-posted to patient accounts or by paper Explanation of Payment (EOP) mailed to your office. Providers not electing electronic funds transfer will receive a check via U.S. Postal Service.

Our electronic 835 remittance advice must use only the HIPPA-compliant action codes. As of Jan. 8, 2014, our paper EOP will contain only HIPPA-compliant action codes and will no longer display Group Health-specific codes. If you have difficultly interpreting the codes, check the Washington Publishing Company's code lists or review your claim via OneHealthPort for Group Health-specific codes (XLS). If you need additional assistance, contact our Provider Assistance Unit.

Denied Claims

We may deny claims for a variety of reasons. Please refer to your 835 RA/EOP for the denial reason.

Members' Financial Responsibilities

A member's financial responsibilities (cost shares) vary depending on the specific plan benefits, copayments, coinsurance, and deductibles. You can check this information using our Eligibility Inquiry tool.

Once we process your claim, you must bill the member for their share of the bill only, as stated on the remittance advice you receive with your payment.

Revised 1/24/2014

The Provider Manual is not intended for any use by any party other than as a resource for Group Health Cooperative's contracted providers in fulfilling their obligations under provider contracts. Group Health intends for the manual to be accurate for its intended purpose but doesn’t guarantee accuracy. Providers should comply with the terms of their provider contracts and any legal requirements in the event of an inconsistency between the manual and a requirement in their provider contracts or the law.