• HIPAA-compliant data file for download directly to your practice management or patient accounting system
• Paper remittance printed and mailed by IntegraNet

Benefits providers may experience include:

• Faster receipt of payments from IntegraNet
• The ability to generate custom reports on both payment and claim information based on the criteria specified
• Online capability to search claims and remittance details across multiple remittances
• Elimination of the need for manual entry of remittance information and user errors
• Ability to perform faster secondary billing

To register for ERA/EFT, please visit our website at www.InetClaims.com or the forms are also on IntegraNet forms page.

Primary Care Provider Reimbursement
IntegraNet reimburses PCPs according to their contractual arrangement.

Specialist Reimbursement
Reimbursement to network specialty care providers and network providers not serving as PCPs is based on their contractual arrangement with IntegraNet.

Specialty care providers must obtain IntegraNet approval prior to rendering or arranging any treatment that is beyond the specific treatment authorized or beyond the scope permitted under this program.

Specialty care provider services will be covered only when there is documentation of appropriate notification or prior authorization, as appropriate, and receipt of the required claims and encounter information to IntegraNet.

Reimbursement Policies
Reimbursement policies serve as a guide to assist you in accurate claim submissions and to outline the basis for reimbursement if the service is covered by a member’s IntegraNet benefit plan. These policies can be accessed at These policies can be accessed at: https://www.IntegraNetHealth.com/page/reimbursement-policies Services must meet authorization and medical necessity guidelines appropriate to the procedure and diagnosis as well as to the member’s state of residence. Covered services do not guarantee reimbursement unless specific criteria are met.

Provider are required to use industry-standard, compliant codes on all claim submissions. Services should be billed with Current Procedure Terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes and/or revenue codes. The codes denote the services and/or procedures performed. The billed code(s) are required to be fully supported in the medical record and/or office notes. Unless otherwise noted within the policy, our policies apply to both participating and nonparticipating providers and facilities.

If appropriate coding/billing guidelines or current Reimbursement Policies are not followed, IntegraNet may:

• Reject or deny the claim.
• Recover and/or recoup claim payment.

IntegraNet’s Reimbursement Policies are developed based on nationally accepted industry standards and coding principles. These policies may be superseded by mandates in provider state, federal or CMS contracts and/or requirements. System logic or setup may prevent the loading of policies into the claims platforms in the same manner as described; however, IntegraNet strives to minimize these variations.

IntegraNet reserves the right to review and revise its policies periodically when necessary. When there is an update, we will publish the most current policy at https://IntegraNetHealth.com.

Reimbursement Hierarchy
Claims submitted for payments must meet all aspects of criteria for reimbursements. The reimbursement hierarchy is the order of payment conditions that must be met for a claim to be reimbursed. Conditions of payment could include benefits coverage, medical necessity, authorization requirements or stipulations within a reimbursement policy. Neither payment rates nor methodology are considered conditions of payments.

Review Schedules and Updates
Reimbursement Policies undergo reviews for updates to state contracts, federal or CMS requirements, and/or IntegraNet business decisions. We reserve the right to review and revise our policies when necessary. Reimbursement policies go through a review every two years for updates to state, federal or CMS contracts and/or requirements and/or IntegraNet business decision. When there is an update we will publish the most current policy at; https://www.IntegraNetHealth.com/page/reimbursement-policies

Reimbursement by Code Definition
IntegraNet allows reimbursement for covered services based on their procedure code definitions or descriptors, as opposed to their appearance under particular CPT categories or sections, unless otherwise noted by state or provider contracts, or state, federal or CMS requirements. There are seven CPT sections:

• Evaluations and management
• Anesthesia
• Surgery
• Radiology (nuclear medicine and diagnostic imaging)
• Pathology and laboratory
• Medicine
• Temporary codes for emerging technology, services or procedures

Various procedure codes are located in particular CPT categories, although the procedure may not be classified within that category (e.g., venipuncture is located in the CPT Surgical Section, although it is not a surgical procedure.