Claims Payment

Remittance Advice (RA)

The purpose of the RA is to report claim activity; it is issued weekly to providers.

You can print copies of claim remittances free of charge from the PrimeWest Health provider web portal using your provider login name and password. If you do not have a login name, call the Provider Contact Center at 1‑866-431-0802 (toll free) to register. You can also register through our website using the provider Web Portal Registration Form.

Electronic Remittance Advice (ERA) (835): Effective July 1, 2019, PrimeWest Health will no longer mail paper remittance advice. To register to receive your remittance electronically for PrimeWest Health medical claims, please complete the Electronic Remittance Advice (ERA) Authorization Agreement and follow the instructions on the form. You can also complete the form electronically through the PrimeWest Health provider web portal. You should also contact your billing software vendor and clearinghouse vendor to confirm setup. 

For registration information for PrimeWest Health pharmacy claim remittances, please refer to the MedImpact Pharmacy Portal or, for additional assistance, contact MedImpact Healthcare Systems, Inc. at 1‑800-788-2949 (toll free).

If you have questions about ERA 835, please call the Provider Contact Center at 1-866-431-0802 (toll free).

For more information on these mandates, please see MN Stat. sec. 62J.536 or visit the Minnesota AUC website.

Electronic Funds Transfer (EFT)

Effective January 1, 2018, PrimeWest Health will require providers to receive their payment by EFT. The EFT process will replace the paper check providers currently receive by mail for services rendered. This process is a free and secure way for providers to receive their payments.

To register, complete the Electronic Funds Transfer (EFT) Authorization Agreement following the step-by-step instructions included with the form. The form must be mailed to the address on the form (faxed forms will not be accepted) along with a voided check or confirmation of account number on financial institution letterhead. You can also complete the form electronically and attach all necessary documents securely through the PrimeWest Health provider web portal.

Once all the required information is received, please allow 30 days for the enrollment process to be completed. EFT payments are typically deposited into your registered bank account within 2 – 3 business days following the claim payment process date.

PrimeWest Health will not produce any additional reports to accompany an EFT payment. The ERA will be your office’s notification of payment. If you are using the provider web portal, you will need to log in and verify payments using the payment search function. Providers should confirm with their bank that the bank will deliver the Corporate Credit or Debit (CCD+) Addenda, which includes a trace number that will give the provider the information needed to re-associate EFT payments with the ERA 835 trace number (TRN02) or re-associate the claim payment information found on the PrimeWest Health provider web portal (trace number and payment date).

If you have questions related to the EFT registration process, please call the Provider Contact Center at 1‑866‑431-0802 (toll free).

Resolving Late/Missing Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) Transactions

Late or missing is defined as a maximum elapsed time of four business days following the receipt of either the EFT or ERA.

If you have received the EFT credit from your financial entity but have not received your ERA, follow the steps below:

1. Contact your clearinghouse to attempt to locate the missing ERA
2. Log into the Provider Web Portal to access your 835. If your clearinghouse is unable to locate the file, contact the Provider Contact Center at 1-866-431-0802 (toll free) for assistance.

If you have received your ERA, but are unable to locate the EFT, follow the steps below:

1. Contact your financial entity to assist in locating the payment
2. If you financial entity is unable to locate the EFT payment, contact the Provider Contact Center at 1‑866‑431-0802 (toll free) for assistance

Refund of Payment

Providers must refund payments to PrimeWest Health when the entire amount paid for a claim needs to be returned or a portion of the payment needs to be returned due to an overpayment (receipt of third party payment, billing error, etc.). Pursuant to section 1128J(d) of the Social Security Act, providers must return any overpayment within sixty (60) calendar days after the date on which the overpayment was identified, and notify PrimeWest Health of the reason for the overpayment.

The preferred method for refund is a corrective adjustment on a future remit initiated by submitting a replacement or void claim (refer to Adjustment Requests, Corrected/Replacement Claims, Attachments, and Coordination of Benefits [COB] for instructions).If you are unable to submit a void or replacement claim you may submit an Adjustment Request Form (refer to Adjustment Requests, Corrected/Replacement Claims, Attachments, and Coordination of Benefits [COB] for instructions).

If you are a provider who infrequently submits claims to PrimeWest Health, please send a check for the full amount of the claim(s) or the full amount of the service line identified as overpaid with a copy of the RA highlighting the paid claim(s) and attach an explanation for the refund. Mail checks with supporting documentation to:

Attn: Claims Department
PrimeWest Health
3905 Dakota St
Alexandria, MN 56308

Assignment/Request for Direct Payment

Providers may obtain an assignment of benefits from the member to ensure direct payment for services. When a dependent child is insured under a group contract pursuant to a court order, providers should request that payment be made directly to them pursuant to Minnesota Statutes. If a PrimeWest Health member is insured by a plan approved in Minnesota, providers may request direct payment from the insurance plan pursuant to Minnesota Statutes. The provider must indicate on the insurance claim form that the person is receiving benefits through PrimeWest Health.

Liability Not Established or Benefits Not Payable

When probable liability is not established, or benefits are not available at the time a claim is submitted, PrimeWest Health will pay the maximum allowable except when Medicare has denied payment on the basis of secondary payer. The provider must accept PrimeWest Health payment as payment in full and must not continue to seek payment from third parties with pending liability. If PrimeWest Health learns of the existence of a liable third party, or benefits become available, PrimeWest Health may recover payment directly from the third party payer.

Prompt Payment

PrimeWest Health is required to pay or deny clean claims within 30 days.

Payment Cycle

Providers are paid on a weekly payment cycle.

PrimeWest Health Reimbursement Is Payment in Full

A provider must accept PrimeWest Health reimbursement as payment in full for covered services provided to a member. A provider may not ask for or accept payment from a member, a member’s relatives, a local human services agency, or any other source, in addition to the amount allowed under PrimeWest Health, unless the request is for any of the following:

1. Copay
2. Insurance payment that was made directly to the member. PrimeWest Health is liable for the amount payable by PrimeWest Health minus the TPL amount.
3. EW waiver obligation

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Updated_12/06/2024