At Vivant Health, we work hard to simplify the claims process. This is for our network providers and those in Vivant Health programs.
We offer comprehensive services and resources. We utilize EDI for claims management. This ensures a smooth and efficient experience for healthcare providers.
Submission by Mail
Transfer (EFT) and Electronic
Remittance Advice (ERA)
at Vivant Health
Below is more information about the claims process.
We use electronic data interchange (EDI) for claims management.
- 24/7 accessibility: Vivant Health accepts all professional and institutional-related claims electronically, 24/7.
- Error reduction: Our system quickly identifies and returns any claims with errors for correction. This reduces the likelihood of rejections or denials.
- Immediate verification: Receive quick acknowledgment and confirmation. You’ll be notified within two days of the acceptance or rejection of your claim.
- Pre-submission checks: Verify patient eligibility and ensure accurate diagnosis and procedure coding.
- Efficient EDI submission: Our user-friendly file EDI solutions are for direct submission or via a clearinghouse. They make sure you have proper file formatting and efficient batching.
- Manual adjudication with EZ-CAP: Automated review flags claims for manual investigation. There will then be a final determination and payment processing.
- Post-submission tracking: Regularly monitor claim status and manage any denials effectively.
- Comprehensive training programs: We provide detailed training for new and existing providers. Training covers all aspects of claims submission and updates.
- Online resources and support: Provider portal for guides, tutorials, and claim submission resources are on hand. Use a dedicated help desk for personalized assistance.
- Regular updates: Stay informed with our newsletters. Get alerts on changes in claim submission processes and payor requirements.
Resources
Confirm patient eligibility with the payor before submitting any claim. This can usually be done online through the payor’s portal or by phone.
Complete the claim form (CMS-1500 or appropriate format for the specific payor) with accurate patient information, diagnosis and procedure codes, place of service, modifiers, and charges. Ensure coding adheres to ICD-10 and CPT standards.
Choose your EDI solution. Directly submit claims through the payor’s portal or use an EDI clearinghouse for bulk submission. Ensure your file format aligns with the payor’s specifications (e.g., HIPAA 837P for professional claims).
After receiving the EDI file, EZ-CAP automatically processes the claim using pre-defined rules and payor contracts. If errors or discrepancies are detected, the claim will be flagged for manual review by a claims adjuster at the payor.
After receiving the EDI file, EZ-CAP automatically processes the claim using pre-defined rules and payor contracts. If errors or discrepancies are detected, the claim will be flagged for manual review by a claims adjuster at the payor.
Please Reach Out to Our Support Team for Any Assistance
Vivant Health’s approach is designed to support all your clinical care and administrative needs. Our dedicated provider relations team, as well as other provider support program staff, work to add value back into your practice by actively assisting you with any challenges or questions. We encourage our providers to utilize these resources to ensure smooth operations and achieve the best outcomes for our shared patient populations.