May 22, 2018 Dear Provider, As a courtesy, we would like to remind you that effective January 1, 2018, Care1st is no longer providing remittance advices (RAs) on paper for services provided to Care1st members. Our new policy requires that all RAs be available only through SECURE electronic download as they contain protected health information/personally identifiable information (PHI/PII). Remittance Advices associated with payments will no longer be issued through any other method. Care1st has established an agreement with Office Ally to provide you electronic remittance advices (ERAs). If you are not already enrolled with Office Ally, you will need to enroll by December 31, 2018 to be able to access your ERAs from Care 1st. Office Ally offers secure ERAs and 835s: 100% free to sign up (you are responsible for your own Internet connection) Quick and easy enrollment 24/7 access to your ERAs If you are already using Office Ally for electronic claims submission, good news--you are already enabled and ready to receive ERAs through Office Ally. If you need to create an account with Office Ally to receive ERAs and/or submit electronic claims, simply enroll online at www.officeally.com. Claims submissions through Office Ally are HIPAA compliant, and you can sign up for Office Ally s electronic claims submission process and never submit a paper claim again, if you choose. If you need assistance, call Office Ally Support at (360) 975-7000, Option 3. Electronic Funds Transfer (EFT) You can also sign up for electronic fund transfer (EFT). With EFT, you no longer need to worry about delayed or lost mailed payments for services provided. To enroll in EFT, please complete the enclosed EFT Instruction Form and return it with a copy of your bank letter or voided check by email to eftinfo@care1st.com or by fax to (323) 765-2706. Enrollment may take 30 days to process. One of our priorities as a company is to do the best job we can in securing our member and provider information. We appreciate your understanding and support regarding these changes in policy as we strive to improve our services. If you have any questions or concerns about the policy described above, or you need assistance with ERA or EFT, please call us at (855) 235-5554. Sincerely, Barry Staton Chief Financial Officer Care1st Health Plan
Electronic Funds Transfer Instruction Form Please complete and send this form with a copy of your bank letter or voided check to enroll or make changes to electronic funds transfer (EFT) with Care 1st Health Plan. Email to: eftinfo@care1st.com or fax to: (323) 765-2706 Please call us at (855) 235-5554 if you have any questions about EFT enrollment or instructions for changes. We will email you confirmation of your enrollment once your request is processed. Please allow us 30 days from the date of receipt of the form to process your request. Thank you! Please print or type of the following information: Company Name: Mailing Address: Tax ID: Group NPI: Effective Date: Individual NPI: Please print or type the following information: Bank Name: Bank Address: Beneficiary Name: Routing Number: Account Number: Account Type (select only one): Checking Savings Please print your name and title below: I, (name), (title) certify that I am authorized as a representative of the organization listed above to sign this document and confirm that the information provided above is correct. Signature: Date: Telephone number: Email Address: Are you currently using a clearinghouse? No Yes Please provide name of your clearinghouse:
Third Party Clearinghouses Do you use any of these clearinghouses listed below? If you do, you may authorize Office Ally to transfer your ERA (835) to one of them by submitting an ERA Transfer Request Form (attached) to Office Ally by email at support@officeally.com or by fax to (360) 896-2151. AdminisTEP Allscripts / PayerPath Athena Health Availity Change Healthcare (formerly Capario, Emdeon, and McKesson) Claimlogic ClaimMD ClaimRemedi Data Systems Group (aka Experian Health) EDI Insight Greenway Health Kareo Navicure nthrive (MedAssets) Optum Insight Passport Health / Nebo Systems PNC Bank / PNC Healthcare Practice Insight RealMed Relay Health Smart Data Solutions (SDS) SSI group Trizetto (aka Gateway) Zirmed
ERA TRANSFER LETTER INSTRUCTIONS AND TEMPLATE If 835s/ERAs have been sent to Office Ally by the Insurance Company (Payer) and were previously being routed to another account, but now need to be routed to a different account OR if ERAs are not being routed to any account and need to be linked to an account, an ERA Transfer Letter is required. This document explains how to submit an ERA Transfer Letter and also contains a template letter for your convenience. This document is NOT an ERA enrollment for any payers, simply to transfer the ERAs currently being received from one account to another. INSTRUCTIONS: To transfer/hardcode ERAs to an Office Ally account, an ERA Transfer Letter is required. A template letter that can be filled out electronically, and then printed on your letterhead, can be found on the next page. The letter must meet the following requirements in order to be processed: Must be printed on the letterhead of the Provider/Group/Company/Practice whom the ERAs are for Must contain: o Name of Provider/Group/Company/Practice whom the ERAs are for o Office Ally Username/ Clearinghouse Name that ERAs are to be transferred or linked to o Statement requesting ERAs be moved/linked to Username indicated o Tax ID the ERAs are for o NPI the ERAs are for o Email address for confirmation of approval or denial o Effective Date for Transfer/Link o Statement that Signer is an Authorized Individual who can sign on behalf of the Provider/Group o Signature of Authorized Individual o Printed Name of Authorized Individual o Title of Authorized Individual MUST be one of these titles: CEO CFO COO Office Manager Owner President/Vice President Once the ERA Transfer Letter has been (1) completed, (2) printed on letterhead and (3) signed by the Authorized Individual; it must be submitted to Office Ally via one of the following methods: Fax to: 360-896-2151 Scan and Email to: Support@OfficeAlly.com Once received and reviewed you should be notified of a denial or approval+transfer/link within 2-3 business days. Please note, it is recommended that this letter is sent separately from any ERA enrollment forms for individual payers. For questions regarding ERA Transfers Please contact us at Support@OfficeAlly.com or (360) 975-7000 option 1. Office Ally PO Box 872020 Vancouver, WA 98687 www.officeally.com Phone: 360-975-7000 Fax: 360-896-2151
RE: ERA Transfer Letter (Must be printed on Provider/Group/Company/Practice Letterhead) Today s Date: To Whom It May Concern: I hereby authorize Office Ally to link any and all 835s/ERAs for the Provider/Group listed below, having the Tax ID and/or NPI below, to the Username/Clearinghouse listed below: Provider/Group Name: Tax ID: NPI: Office Ally Username / Clearinghouse Name: (MUST BE ADMIN USERNAME, NOT _SA ACCOUNT) Email Address: _ (List email address for confirmation of approval+transfer or denial) Please move all ERAs over to this new account as of this date: NOTE: If you want us to transfer old ERAs to the new username, please list the date to go back to above. By signing below, I certify that I am an authorized individual for the Provider/Group, Tax ID(s) and NPI(s) listed above and that I am authorized to sign on their behalf. Authorized Individual s Signature Printed Name of Authorized Individual Title of Authorized Individual