Claims

Effective June 1, 2019, Physicians of SW Washington no longer accepts paper claims.

Participating providers and facilities agree to bill PSW directly via electronic submission for covered services within one year of the date of service. To ensure claims are routed to the correct location, the back of each Member ID card should be reviewed for EDI submission ID.

Submission Process
Claims must be submitted electronically, following 5010 guidelines and using PSW’s Payer ID # 91171. Attachments cannot be accepted at this time via EDI claims.

Please use our Medical Record Routing Form for attachments less than 25 pages.

Records more than 25 pages can be mailed to 319 7th AVE SE, Suite 201, Olympia, WA 98501 – preferably on a password protected CD-ROM. Please send each document (i.e. Med Rec and IS) on a separate file within the CD-ROM. Password can be faxed to 360.754.4324 attn: Claims.

Time Frame to Submit
Claims must be submitted and received at PSW within 365 days from the date of service. In order for a claim to be considered timely, it must be a Clean Claim and have been received at PSW. Claims must be submitted on a timely basis; if submitted beyond timely filing guidelines, claims will be denied and the provider has no formal channels of appeal. Providers may not charge a beneficiary in cases where the claim was not submitted timely, except for copay/coinsurance amounts, as would have been appropriate if payment had been made.

Corrected Claims
A corrected claim must be submitted within 365 days from the date of service to be considered for payment. A corrected claim is any claim that has a change to the original claim (e.g., changes or corrections to diagnosis, procedure codes, date of service, charges, etc).

Checking Claim Status
Providers should allow 45 days for the processing of their claim before contacting PSW for claim status. PSW offers a self-service website providerpayments.com where claims details are located once payment has been finalized. If providers have questions about the processing of claims after reviewing providerpayments.com, the PSW claims department can assist with additional questions.

If you have additional questions regarding your payment options, please contact ECHO Health at 440-835-3511.

A blank form from ECHO for all PSW health plans can be located by clicking here.

Premera

Helpful tips to ensure you submitting claims properly for your PSW/Premera MA Members:

1. Always check the back of the card at every office visit
   
   
2. Verify eligibility and coverage for Premera at www.onehealthport.com
3. When submitting claims, follow the below:
   1. Do not include the “ZNP” on the member id
   2. DO include the  double zero’s “00” that follow the 9 digit member #.