Claims & Reimbursement
Submit claims electronically for professional and facility services (ANSI X12 837). All claims must be submitted electronically using an 837 EDI transaction set. Claims will be submitted outside the HRSA COVID-19 Uninsured Program Portal. Reimbursement is subject to available funding.
to Patient RosterLess than 24 hours
PaymentApproximately 10 business days
Once a TIN is validated and set up with Optum Pay, claims that are eligible for reimbursement are typically processed and paid within 30 business days.
Important! The HRSA COVID-19 Uninsured Program is using a unique version of Smart Edits, which is an EDI capability that detects electronic claims with potential errors. When a claim is submitted with a potential error, Smart Edits sends a message back to the submitting care provider to explain why the claim was rejected and provides direction on how to resolve it as part of the X12 277CA claim level response. Repaired claims should be sent with the original frequency code of 1, not with a replacement or voided claim indicator of 7 or 8. The submitting care provider is responsible for working their 277CA and resolving rejections as applicable to avoid denials. We have established this process to help you catch claims billing errors and correct them because all claims submitted will be complete and final. Interim bills, corrected claims, late charges, voided claim transactions and appeals will not be accepted. Learn more about Smart Edits in this FAQ (PDF) and Reference Guide (PDF).
1. Submit Claims
All claims must be submitted electronically using an 837 EDI transaction set. Claims will be submitted outside the HRSA COVID-19 Uninsured Program Portal.
Include the following information as part of the claim submission, and learn more about EDI via these tools:
Program participating clearinghouses / vendors (PDF)
837 Claims Submission Companion Guide (includes payer address) (PDF)
276/277 Claims Status Inquiry and Response Companion Guide (PDF)
You Will Need
- Payer ID: 95964
It's important to submit claims using the new payer ID 95964 for the program; do not use another payer ID. - Payer name: COVID19 HRSA Uninsured Testing and Treatment Fund.
- Temporary member ID for each patient This information will be found in the program portal after provider submits patient roster.
See coverage details and billing codes for more information on what is covered and coding requirements.
Claims processing timing expectations
- EDI claims received each day by 4:00 p.m. ET will be initiated through claims processing at 7:00 a.m ET the next day (day 1). E.g., if claim is submitted at 3:45 p.m. ET on May 20, it will be initiated through claims processing at 7 a.m. ET on May 21.
- EDI claims received each day after 4:00 p.m. ET will be initiated through claims processing at 7:00 a.m. ET the following day (day 2). E.g., if claim is submitted at 4:15 p.m. ET on May 20, it will be initiated through claims processing at 7 a.m. ET on May 22.
- Claims submitted on a Friday, Saturday or Sunday may take an additional 1-2 days due to weekend processing.
As new reimbursement codes involving COVID-19 testing, treatment and vaccinations are created, the HRSA COVID-19 Uninsured Program may temporarily hold claims involving newly created reimbursement codes until CMS publishes corresponding reimbursement information. Participating clearinghouses will receive weekly email updates with details.
Claim status inquiry and response (X12 276/277) is available for this program with vendors/clearinghouses that have chosen to participate. Please contact your vendor/clearinghouse to verify participation.
All claims submitted must be complete and final. Corrected claims, late charges, voided claim transactions and appeals will not be accepted. Interim bills may be accepted for outpatient hospital claims with dates of service that cross over a calendar year.
- Payer ID: 95964
2. Receive Payment Electronically
Receive payment electronically once claim is processed and approved for payment. Once a TIN is validated and set up with Optum Pay™, claims that are eligible for reimbursement are typically processed and paid within 30 business days.
Claims Payment Status
You will be able to download an 835 file, as well as download the Electronic Provider Remittance Advice (PDF version of the 835 file) for the HRSA COVID-19 Uninsured Program, by accessing Optum Pay with your One Healthcare ID. On the Optum Pay website you can access your remittance information on the View Payments tab. You can find that tab by following this path:
- Log in to Optum Pay .
- Select the Tax Identification Number (TIN) associated with the claims you are looking to reconcile.
- Select View Payments.
You will need to be able to access the 835 file in order to upload it into your practice management system. This will allow you to reconcile your claims as you would if you had received the 835 file via your clearinghouse. Please allow for appropriate processing time. As part of the HRSA COVID-19 Uninsured Program, the 835 file will not be electronically routed to you from your clearinghouse.
