Claims Status/Online Claims Look Up
To obtain information on the status of your claims, please log on to the Provider Portal or call our Provider Customer Service Line at
800-261-3371, available Monday through Friday, 8:30 a.m. – 5 p.m.
Find out the guidelines for timely claims submissions and what is required for the claim to be considered clean.
Are you submitting claims electronically? Learn how to send your MedStar Family Choice claims electronically.
Electronic Funds Transfer (EFT) / Electronic Remittance Advice (ERA)
Beginning on January 1, 2023, MFC’s only direct clearinghouse partner will be Change Healthcare and ECHO Health, Inc. to provide EFT payments and 835 Electronic Remittance Advices (ERA).
To sign-up to receive EFT, through Settlement Advocate for MedStar Family Choice, Inc only, visit https://enrollments.echohealthinc.com/EFTERADirect/Medstar. No Fees apply.
All generated ERAs will be accessible to download from the ECHO provider portal (www.providerpayments.com). You can also log into www.providerpayments.com to access a detailed explanation of payment for each transaction. Changes to the ERA enrollment or ERA distribution can be made by contacting the ECHO Health Enrollment team at 440-835-3511.
Please make sure that your Practice Management System will be updated to accept the Change Healthcare Payer IDs as identified for each respective MedStar Family Choice Health Plan:
- MedStar Family Choice – District of Columbia: RP062
- MedStar Family Choice – Maryland HealthChoice: RP063
If you have any difficulty with the website or have additional questions, please call 800-317-3523.
Learn where to send refunds for errors in claims payments.
Learn how to submit a payment dispute.
Understand the laws pertaining to the prevention and detection of fraud, waste, and abuse, in accordance with the requirements of the federal Deficit Reduction Act of 2005.
Prior authorization is required for elective and direct placement into observation (e.g., from home, physician office).
Click on the link above for the ICD-10-CM version of the Emergency Room Auto-Pay List.
The National Drug Code is required to be billed on claim forms for drugs administered by physicians, outpatient hospitals, and dialysis centers.
Third Party Liability Requirements for Medical Support Enforcement Beneficiaries
Medstar Family Choice updated billing processes to reflect updates to CMS’s third-party liability (TPL) requirements regarding medical support enforcement beneficiaries. These requirements are outlined in 42 CFR § 433.139(b)(3), and impact both professional and institutional providers. Medstar Family Choice is now required to pay and chase claims for medical support enforcement beneficiaries for which the provider has:
Billed the TPL and not received a response; and
•Waited at least 100 days from the date of service before billing the Department.
To comply with these requirements, providers must submit an attestation form alongside CMS 1500 and UB-04 forms when billing claims for medical support enforcement beneficiaries.
Overview of Attestation Forms
CMS 1500 Box-11 Rejection Reason S Provider Attestation Form: This form is intended for use by professional providers seeking reimbursement for third party liability claims where the provider has not received payment, and the provider is billing the claim using rejection reason S. The purpose of this form is to allow providers to attest their reason for using rejection reason S, and provide appropriate supporting documentation.
UB04 Billing Without Occurrence Code Attestation Form: This form is intended for use by institutional providers seeking reimbursement for third party liability claims where the provider has not received payment, and no existing occurrence code is applicable. The purpose of this form is to allow providers to attest their reason for billing their claim without an occurrence code and provide the appropriate supporting documentation. Providers are NOT required to use any of the existing TPL override occurrence codes (24 or 25) listed in the UB04 Billing Guidance.
Information current as of: