Claims Submission Protocols And Standards

Claims Submission Protocols And Standards

 Prestige Health Choice will reimburse providers for the delivery of covered services as follows:

1. Claims are considered received on the date the claims are received by Prestige.
2. Providers must mail or electronically transfer (submit) the claim to Prestige Health Choice within the time frame allowed by their contract (generally 90 days for physicians and 180 days for hospitals.)
3. Non-contracted providers must mail or electronically transfer (submit) the claim to Prestige Health Choice within six (6) months of:

a. The date of service or discharge from an inpatient setting; or,
b. The provider has been furnished with the Enrollee’s correct name and address

Electronic Claims Submission

Providers have the option of submitting claims electronically through Electronic Data Interchange (EDI). The advantages of electronic claims submission are as follows:

• Facilitated, expedient claims payment
• Acknowledged receipt of claims electronically (through EMDEON -formerly known as WebMD and ProxyMed)
• Improved claims tracking
• Improved claims status reporting
• Improved turnaround time for timely reimbursement
• Eliminated paper
• Improved cost effectiveness

To initiate the electronic claims submission process or obtain additional information please contact EMDEON at

1-800-845-6592.
Prestige Health Choice Payor ID # 45056
Paper Claims Submission
Prestige Health Choice
PO Box 6018
Hauppauge, NY 11749

 Prestige Health Choice will reimburse providers for the delivery of covered services as follows:

1. Claims are considered received on the date the claims are received by Prestige.
2. Providers must mail or electronically transfer (submit) the claim to Prestige Health Choice within the time frame allowed by their contract (generally 90 days for physicians and 180 days for hospitals.)
3. Non-contracted providers must mail or electronically transfer (submit) the claim to Prestige Health Choice within six (6) months of:

a. The date of service or discharge from an inpatient setting; or,
b. The provider has been furnished with the Enrollee’s correct name and address

Electronic Claims Submission

Providers have the option of submitting claims electronically through Electronic Data Interchange (EDI). The advantages of electronic claims submission are as follows:

• Facilitated, expedient claims payment
• Acknowledged receipt of claims electronically (through EMDEON -formerly known as WebMD and ProxyMed)
• Improved claims tracking
• Improved claims status reporting
• Improved turnaround time for timely reimbursement
• Eliminated paper
• Improved cost effectiveness

To initiate the electronic claims submission process or obtain additional information please contact EMDEON at

1-800-845-6592.
Prestige Health Choice Payor ID # 45056
Paper Claims Submission
Prestige Health Choice
PO Box 6018
Hauppauge, NY 11749

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