Information for Providers

Claims & Billing

Forms & Links

Claim Attachment Cover Sheet (Fax: 715-787-7308) (PDF)
Fraud, Waste and Abuse
Gender Identity Information Form (PDF)
Provider Claim Reconsideration Form (PDF)
Provider Guide: The Explanation of Payment (EOP) (PDF)
Provider Notification Change/Update/Termination Third-Party Agreement (PDF)
Waiver of Liability (PDF)

Resources for Electronic Transactions

Electronic Data Interchange (EDI)

To simplify and streamline transactions, Aspirus Health Plan supports a variety of electronic data interchanges.

Important Definitions and Acronyms (PDF)

Electronic Claims Submission

Aspirus Health Plan accepts electronic claims submission through the below trading partner:

Change Healthcare
(formerly RelayHealth)
Phone: 1-877-411-7271
CHC_pcssupport@changehealthcare.com
www.changehealthcare.com

270/271 Eligibility and Benefits

Providers can access the 270/271 transaction via Change Healthcare PCS Support. If your clearinghouse has not already done so, they can enroll with PCS to begin transmitting these transactions to your organization. Have your clearinghouse contact CHC_pcssupport@changehealthcare.com or call 1-877-411-7271 to begin the enrollment and provisioning process.

HIPAA Transaction Standard Companion Guide 270/271 Health Care Eligibility Benefit Inquiry and Response (PDF)

This Companion Guide is intended to describe to Aspirus Health Plan’s trading partners the content and format of the Eligibility and Benefit 270/271 transaction set in the EDI environment.

276/277 Health Care Claim Status Inquiry and Response

Providers can access the 276/277 transaction via Change Healthcare PCS Support. If your clearinghouse has not already done so, they can enroll with PCS to begin transmitting these transactions to your organization. Have your clearinghouse contact CHC_pcssupport@changehealthcare.com or call 1-877-411-7271 to begin the enrollment and provisioning process.

HIPAA Transaction Standard Companion Guide 276/277 Health Care Claim Status Inquiry and Response (PDF)

This Companion Guide is intended to describe to Aspirus Health Plan’s trading partners the content and format of the Health Care Claim Status Inquiry and Response 276/277 transaction set in the EDI environment.

835 Electronic Remittance Advice

Providers can access the 835 Remittance via Change Healthcare PCS Support. If your clearinghouse has not already done so, they can enroll with PCS to begin transmitting these transactions to your organization. Have your clearinghouse contact CHC_pcssupport@changehealthcare.com or call 1-877-411-7271 to begin the enrollment and provisioning process.

HIPAA Transaction Standard Companion Guide 835 (ERA) Electronic Remittance Advice Health Care Claims Payment/Advice (PDF)

This Companion Guide is intended to describe to Aspirus Health Plan’s trading partners the content and format of the Electronic Remittance Advice 835 transaction set in the EDI environment.

Taxonomy Code Requirements

Aspirus Health Plan requires the corresponding taxonomy to be submitted whenever a National Provider Identification (NPI) is reported on a claim. When taxonomy is not reported on a claim that includes a NPI number(s), the claim will be rejected. Provider types that are not required to submit claims with NPI are not required to submit taxonomy on claims to Aspirus.

Taxonomy Codes Required (PDF)
Taxonomy Code Requirements; Frequently Asked Questions FAQ (PDF)