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Claims for Embark, Vantage members will be reported on our Claim Voucher, produced every Saturday and mailed no later than Monday. Vouchers are arranged in a new, easy to read, easy to understand format.
- Vouchers are sorted by clinic, then alphabetically by provider
- Individual claims are then sorted by original claims and adjusted claims followed by payment and pended claims summaries sent with the voucher
- You will receive payment for your Embark, Vantage patients separately from your other Asuris patients
- A guide for reading the Claim Voucher and summaries follows:
Provider office managers helped design the vouchers. The easy-to-read vouchers for these patients include:
- Boxes around the headers for each amount
- Line by line breakdowns
- Codes billed by line item, then, if applicable, the code(s) bundled into them
- Specific message codes
Explanation of payment voucher fields:
A – Provider Information |
Provider name |
Date of check that accompanies this voucher |
Asuris provider identification number |
Voucher number |
National Provider Identifier (NPI) |
Voucher page number |
B – Reference Information and Voucher Field Headings |
Name of Network |
Customer Service number for providers |
Date of Service (From/Through) |
Paid By Others |
Procedure Code and Modifier if any |
Risk Withhold |
Units |
Amount Paid |
Billed Amount |
Patient Responsibility (Deductible, Copay, Non-covered, Total) |
Allowed Amount |
Interest Paid |
Contractual Adjustment |
Message Codes |
C – Patient Information |
Patient name |
Network |
Patient account number (if one was submitted on the claim) |
Member’s group number |
Member number (the alpha prefix will be included for out-of-area BlueCard® members) |
Rendering provider’s name |
Insured name |
Claim number |
D – Claims Information |
First and last dates of service |
Amount paid by another carrier |
CPT, CDT, or HCPCS codes billed and any modifier |
Risk withhold |
Units of each procedure code billed |
Amount paid by Asuris |
Total billed amount for the service |
Amount of patient responsibility, including deductible, copayment, coinsurance or any non-covered services, and the total patient responsibility |
Amount allowed by member’s plan |
Any interest paid |
Contractual adjustment |
The message code/explanation indicating how this particular claim was processed |
E - Total Payment Information for this voucher |
Total billed amount |
Total amount paid by Asuris |
Total allowed amount |
Total interest paid |
Total contractual adjustments |
Total balance forward |
Total paid by others |
Total amount previously paid |
Total risk withhold |
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Please refer to the Billing Information section in the Provider Manual, available on the Provider Web Site for examples of an adjusted claim voucher, a sample payment summary and a sample pended claims summary.
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