USHL claims are processed by jointly-owned Automated Benefit Services, Inc. (ABS). Once the selected method of claim submission is implemented, the process is tested and verified.
Claim Submission File Requirements
ABS can accept ANSI X12 version 5010 for all 837 transaction sets (institutional, professional and dental).
ABS processes ANSI X12 837 institutional professional files. We verify all inbound x12 file to WEDI SNIP Level2.
Information on formatting can be found at www.wpc-edi.com.
ABS requests that files be submitted with no greater that 500 claims per file.
No more than one (1) ISA/IEA per file.
Each file can contain more that one GE/GS envelope.
Individual claims can be wrapped in their own GE/GS envelope.
Once claims are processed, providers can choose to receive explanation of benefits (EOBs) in either electronic (EDI X 12) or paper form.
Available claim submission options:
RelayHealth
Claims can be processed directly through ABS’s contracted clearinghouse, RelayHealth. A secure link to the provider office must be established – contact RelayHealth at 800-527-8133, Option 2 or go to www.relayhealth.com.
Alternate Clearinghouses
Providers working with a clearinghouse other than RelayHealth may continue to work with their current vendor, assuming that vendor can push files to RelayHealth. Contact RelayHealth (at the number above) or your clearinghouse regarding this relationship.
RelayHealth PCS Portal
Trading partners transmitting claim volumes in excess of 200 claims daily should utilize the ABS RelayHealth PCS Portal. Contact ABS EDI Support for portal access instructions.
Direct FTP
This method of claims submission is not recommended; however If you choose this method, you must contact ABS EDI Support for proper implementation of FTP protocols.
Paper Claim Submission
Although paper claim submission is not recommended, providers having only this capability can arrange such submission by contacting ABS EDI Support. UB-92 (institutional) and CMS-1500 (professional) paper forms are accepted for processing. Paper claims should be submitted to USHL, P.O. Box 37504, Oak Park, MI 48237.
