Amisys – Zelis Electronic Payment Program
Date: 01/02/25
Amisys – Zelis Electronic Payment Program
ACH+
To reduce the environmental impact of our payments and to enhance provider experience by offering additional payment modalities, all paper check payments for Medicaid, Medicare, and Marketplace on the Amisys will be issued via ACH+. The solution will be administered in partnership with Zelis (Payspan).
This document provides Frequently Asked Questions (FAQs) gathered to date for Provider Representatives, Provider Relations, and Leadership:
ACH+: General Information | |
1 | Will ACH+ eliminate paper checks? Yes. Providers that have selected ACH+ as their payment modality of choice with Zelis will no longer receive paper checks. |
2 | How does ACH+ work?
Providers can contract with Zelis and pay a nominal fee to receive direct deposits on behalf of all Zelis payer partners. This allows providers to receive all payments, 835s, and customer service through a single, seamless connection with Zelis, encompassing multiple payers.
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3 | Which providers are being transitioned to ACH+? ACH+ will be offered to any provider directly contracted with Zelis for this convenience. |
4 | When will providers be transitioned to ACH+
Providers will be transitioned to ACH+ starting in early 2025.
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5 | If a provider has questions regarding their ACH+ payment, who do they contact?
Providers with questions about payment amounts, adjustments, etc., will continue to be serviced by our contact center. If a provider has questions about how payment was disbursed, how to access funds, the Zelis portal, etc., call center representatives can direct them to Zelis Provider Services via 877-828-8770 or ClientService@zelispayments.com.
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6 | The provider was getting a paper check with Payspan. What will their payment experience be with Zelis?
Payspan payments that were issued via check will begin processing through the Zelis Payments Network as the provider's existing Zelis Payments are today. Providers will receive the electronic payments as ACH, honoring the provider’s choice to enroll in ACH+.
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7 | Can a provider opt out of ACH+?
Yes, providers have the option opt out or update their payment preferences in the Zelis Payment Network. Providers can contact Zelis Provider Services via 877-828-8770 or ClientService@zelispayments.com if they have questions or want to change their payment method. Providers always have a free EFT solution available via www.payspanhealth.com. Providers can contact Payspan® via email at providersupport@payspanhealth.com or by phone at 877-331-7154, Option 1
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8 | How can I tell if a provider was paid ACH+
Payment modality will continue to show “check” in Amisys. Contact Center staff can access the Payspan portal to view payment modalities as they do today. Things to note: · The original payment information will still say ‘check’ in Payspan. · The Disbursement method will note the payment’s final modality o Zelis Network- ACH Payment
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1 | Who can health plans contact for Claims Operations Payable Issues for ACH+ post go-live? Health Plan employees can submit a Business Operations Issue Form (job aid below) so that any Claims Operations Payables issue you may have can be reviewed and resolved efficiently. Important Note: Please refrain from sending emails (emails can get overlooked and are hard to track or trace) if this form serves your needs.
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Business Operations Issue Form Job Aid – Claims Operations Payables
The purpose of this Job Aid is to communicate how to submit a Business Operations Issue Form so that any Claims Operations Payables issue you may have can be reviewed and resolved efficiently.
Important Note: Please refrain from sending emails (emails can get overlooked and are hard to track or trace) if this form serves your needs.
Where can I find the form?
There are three ways to access the form:
1. Request Central Path - Home >> Service Catalog >> Something Broken >> Business Operations Issue
2. Hyperlink – Business Operations Issue form
3. Search on Request Central Home page for “Business Operations Issue”
What does the form look like?
How do I fill out the form? Below are the fields that you will need to enter information into:
1. Request Type (Required) – Select the ‘Problem Management’ radio button.
2. This request for Claims is being submitted on behalf of. (Required) – Select the option that best describes your department.
3. Please select the applicable system/application associated with your Claims issue? (Required) – Note: Review the request types below to determine the best option to select.
GROUP/ASSIGNEE | TYPE OF ISSUE |
ACCUMULATORS
| · Requests for assistances related to the accumulator engine system issues. · Requests when a key vendor has identified that transactions are not flowing appropriately. · Requests from a vendor requesting reconciliation per direction of the accumulator staff. · Requests from a Health Plan or any escalated requests. |
MEMBER CORRESPONDENCE
| · Requests to create or update an Explanation of Benefits (EOB) template · Requests to create or update a new Service Verification Form (SVF) · Requests to create or update a Notice of Adverse Benefit Determination (NOABD) letter · Requests to create or update a Contest Letter · Requests to create or update a Year To Date (YTD) SB368 · Requests to create or update a Zero Cost Share Dual Eligible Special Needs (DSNP) Maximum Out Of Pocket (MOOP) Letter · Requests to update Multi-Language Insert (MLI) an/or Non-Discrimination Notice (NDN) · Requests for Translation of a member correspondence document (Medicare Only or as required by State/Federal request) · Requests to create or update an Integrated Denial Notice (IDN) · Requests for copies of an EOB, SVF, Contest or NOABD correspondence that cannot be found in Optum (Formerly Change Health Care) or FileNet. · Requests to pull large numbers of EOB’s, SVF’s Contest and/or NOABDs (20 or more) · Legal requests for multiple EOB’s, SVF’s Contest and/or NOABDs · Requests where an Ambetter EOB is not found in the member portal. Note: Route these requests to the Chat_Amber_Support assignment group. |
PROVIDER CORRESPONDENCE | · Requests to create a new Explanation of Payment (EOP) template. · Requests to update an existing EOP · Requests to create a new paper check template · Requests to update an existing paper check template · Requests for copies of an EOP/ERA that cannot be found in Zelis (Formerly Payspan) or Optum (Formerly Change Health Care). · Legal requests for EOPs/ERAs · Requests for copies of an EOP/ERA that cannot be found in Zelis (Formerly Payspan) or Optum (Formerly Change Health Care). · Requests to pull large numbers of EO’s (20 or more) |
PROVIDER DATA
| · Requests to review provider portal issues · Requests related to Zelis (Formerly Payspan) or Optum (Formerly Change Health Care) concerns (EFT/ACH) · Requests related to provider payment set up (EFT-Zelis, Paper-Optum) · Requests to review/access web portal issues |
ABS DISALLOW/DENIAL CODE, AMISYS EX-CODE, XCELYS REASON CODE REQUESTS AND/OR UPDATES | · New Reason Code Request(s) · Reason Code Update Request(s) · CARC/RARC Issue Review · Reason Code Crosswalk |
CYPRESS/EDI INSULATION/POST PAYABLE ERRORS
| · Requests for review of claims hitting Cypress/EDI insulation/PPS Errors that Claims Analysts are unable to resolve. (Claims hitting the Cypress daily reports or pending EXto ONLY). Note: This would exclude any rule failures. |
PPS (PROVIDER PAYMENT SYSTEM) | · Requests for review claims stuck in PPS. Note: These cannot be claims that are pended. |
4. Summary of Issue (Required) – Provide a brief description of the issue or concern.
5. Please describe the issue you are experiencing including workflow being performed and include screenshots of any error messages you have received by using the paper clip icon (Add attachments) below. What do you think caused the issue? (Required) – Please include a detailed description here. Please provide as much non-PHI related information as possible in this field.
6. Do you have any Claim Numbers as examples – Provide any claim numbers relevant to your request.
7. Do you have EX Codes as examples - Provide any EX-Codes Codes that are relevant to your request.
8. Line of Business (Required) – Select all lines of business being affected or that require an update. Note: For EX Code requests, select Enterprise if all lines of business need an update.
9. Please select the Corporate Entity – Select all that apply
10. Health Plan (Required) - Select all that apply
11. State (Required) – Select all that apply
12. Additional States - Select any additional States that your issue applies to.
13. Does this have a Regulatory or Compliance Impact? (Required) – Yes or No? If Yes, fill in the next section with specific information related to the impact.
14. Has a formal complaint ticket been submitted through the DOI/OIC/CTM Process – Yes or No? If Yes, provide the complaint ticket number in the field selected and the date a response is due in the fields below.
15. Is there a manual work around? (Required) - If Yes, fill in the next section with any manual or automated steps that address the issue.
16. How many claims does this impact? How many claims are negatively affected due to your request? (Required) – Select an option
17. What is the dollar threshold in Billed Charges? This should capture savings, ROI, etc., based on the impact. (Required) – Select an option
Please fill in all the required information. Not doing so may result in a delay in handling your request.