Paper Checks Coming for Some Individual Plan Network Providers

Starting April 12, 2024, you may receive paper checks for claims payments for care provided to individual plan members, instead of electronic funds transfer (EFT) payments. Paper checks will be mailed to your provider billing address. Here’s what you need to know:

Why did I receive a paper check instead of an EFT payment?

Provider electronic payments are dependent on accurate TIN/NPI2 (Billing NPI) combinations and subject to CMS guidelines. At this time, we have key gaps in the provider NPI data files sent among the companies involved in EFT payments.

You’ll receive a paper check if you have mismatched service location NPI and billing location NPI data, missing NPI2 information, or you have more than one TIN associated with your NPI.

Can I fix the issue in InstaMed?

There is no action for you to take at this time.

We were hopeful asking you to update your InstaMed accounts would fix the data and compliance issues within our EFT system. Additional testing has revealed an outstanding problem reconciling information between all the involved databases. We don’t have a way to complete EFT reimbursement for all providers in compliance with CMS guidelines. Compliance issues and your satisfaction are top concerns for us, and work is underway to determine a long-term solution.

How can I track which payments I received via paper check?

Your Explanation of Payment (EOP) gives you information about the adjudication of your claims. You can view EOPs in the Evolent secure provider portal.

Who can I contact?

If you have questions, contact Premera Customer Service at 800-817-3056 between 8 a.m. and 6 p.m., Monday through Friday, Pacific Time.