Electronic Claims FAQ

Frequently Asked Questions

Advantages to submitting claims electronically include:
  • Faster turnaround time for payment
  • Improved claim control
  • Tracking capabilities
  • Automation of receivables information
  • Error reduction
The following steps should be completed prior to sending transactions electronically.
  1. Contact a PSI representative to verify we can work directly with your Medical Benefits Clearinghouse.
    • If yes, we will have your Clearinghouse set up to process claims through PSI.
    • If this is not an option, you can submit claims manually through our Claims Entry Portal (coming soon).
  2. Send a claims test file.
  3. Once a test claim has been submitted successfully, you may continue submitting claims through your Practice Management Software or the PSI Claims Entry Portal (coming soon).
The standard transaction formats and associated code sets that are mandated by HIPAA can be reviewed at CMS/HIPAA Electronic Transactions & Code Sets website.
PSI supports the transaction formats and associated code sets as mandated by HIPAA.
The subscriber ID is the 10 digit patient ID number listed on the PSI payment assistance card.
PSI currently uses Emdeon (Payer ID CB733), Gateway EDI (Payer ID PSI01), Relay Health (Payer ID- CPID 6298 for professional claims and Payer ID-CPID 5656 for institutional claims), and ENS/Ingenix (Payer ID CB733) for electronic claims submission.
Yes, in the near future the status of a claim can be easily verified if you are submitting claims through the PSI Claims Entry Portal. This feature is coming soon.
A claim could be rejected if:
  • It is greater than 6 months old
  • It is outside of the patient's PSI eligibility range
  • A patient's unique PSI ID number is entered incorrectly
  • It is not for an approved or covered PSI service
  • The patient's primary insurance has not yet paid on the claim
  • The DOS has already been submitted or the claim is a duplicate
  • The patient portion exceeds the program maximum allowed
  • The patient has met their insurance CAP or maximum
A provider can check a patient's eligibility status through the Validation Portal which displays if the patient is currently eligible for PSI assistance.
If a claim is submitted incorrectly, contact a PSI representative at 1.866.392.1309 to determine the easiest way to correct/adjust the claim.
Paper claims are still being accepted through PSI; however, our preferred method of claim submission is electronic.
Providers are mailed paper checks at this time.