Referral Submission
Submitting a request for home health, hospice or infusion services using an order from the patient physician.
Authorization and Re-Authorization
Submitting an authorization/reauthorization request is simple and streamlined in the NorthCoast Portal. This request should include specific details on the service requiring authorization to provide services as ordered by the patient physician.
Benefit Verification
Benefit verification can be submitted without a referral. Should your benefit verification turn into a referral, verifying benefits only does not put your referral ahead of other referrals and the referral does not move for processing until we have received all the necessary information to submit a referral to the payer for authorization.
Electronic Claims (837)
An 837 file is an electronic file that contains patient claim information. This file is submitted to an insurance company or to a clearinghouse instead of printing and mailing a paper claim.
Claim Status Reporting
A report including status information about the processing of a claim. This is a communication between a provider and a payer/network manager about a health care claim.
Electronic claims payment (835)
An 835 is also known as Electronic Remittance Advice (ERA). It is the electronic transaction that provides claim payment information and documents the EFT (electronic funds transfer). An 835 is sent from insurers/network manager to the healthcare provider.
Denials and Appeals
Claims can be denied payment or processing depending on the patient benefits or the submission of a “clean claim” meeting all insurers requirements. Appeals can be submitted on denied claims and typically have a limit on the timely file.
Patient Responsibility Invoicing and Collection
Patient responsibility is commonly described as the total amount a patient owes out of pocket. If the patient is insured, it may include copayments or coinsurance. NorthCoast will send patients monthly invoices showing the amounts due as assigned by their health plan.
