To request a new ID card please call Customer Service at 866-607-0117. It usually takes 7-10 business days for your new card to be mailed.
To terminate your plan or dependent, please send an email to firstname.lastname@example.org. Be sure to include each person you are terminating including their member ID and the date of the termination. All terminations take effect, the end of the month.
HMO Health Plan #: 000000
Group #: 123456
John Doe ID #12345678901
Jane Doe ID #12345678902
Baby Doe ID #12345678903
Child Doe ID #12345678904
Generic Drugs $10 copay
Preferred Brand Drugs $50 copay
Non-preferred Brand Drugs 50%
Specialty Drugs 50%
Effective Date: 01/01/2016
All participating providers are responsible for verifying an Enrollee’s eligibility at each and every visit. Providers can verify enrollee verification through one of two methods:
You have the option of submitting claims electronically or by mail. We encourage use of electronic claims submission methods to help you:
Providers choosing electronic submission must use the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) compliant 837 electronic format, or a CMS-1500 and/or UB-04, or their successors.
Vista360health utilizes TriZetto as a clearinghouse. Because most clearinghouses can exchange data with one another, providers should work with their existing clearinghouse to establish EDI with Vista360health. Please contact Provider Relations if assistance is needed.
|Clearinghouse||Payer ID||Clearinghouse Payer ID|
|TriZetto||V360H (Professional Claims)||Phone: 1-800-556-2231|
|www.trizettoprovider.com||V360I (Institutional Claims)||Email: email@example.com|
Paper claims can be submitted to the address on the Enrollee Identification Card noted below:
P.O. Box 15402
Austin, Texas 78761
ELECTRONIC PAYMENT METHODS (EFT/ERA)
Vista360health offers the ability to receive claims payments and remittance advices electronically. Both options offer benefits over paper transactions. Forms can be accessed from our Provider Portal (coming soon!) or your Provider Relations Representative.
Electronic Funds Transfer (EFT)
Electronic Funds Transfer (EFT) is the electronic exchange of claims payments. It is safe, secure and quicker than paper check payments. EFT allows payment to be deposited electronically directly into a bank account once claims payment is released. There is no need to manually deposit checks.
Electronic Remittance Advice (ERA)
Electronic Remittance Advice (ERA) enables you to receive claims payment information electronically. ERA files are transmitted in the HIPAA mandated ASC X12 835 5010 A1 format. ERA allows providers to post claims remittance advices electronically to your billing software vendor or clearinghouse to automate manual processes.
Providers can verify the status of their submitted claim status telephonically by contacting Vista360health Claims Customer Service at 1-800-607-0117 or directly through our Provider Portal. Once claims have been received and entered into our systems, claims in the Provider Portal (coming soon!) will reflect a status of Paid, Denied or Pending.