Features of EPS with direct deposit or Virtual Card Payments:

Electronic Payments and Statements EPS

• Receive payments and EOBs five to seven days faster than with paper

• Multiple claim payments generated in one day for the same payer are combined into one deposit or VCP and one electronic EOB for easy reconciliation

• Simplified processing and reconciliation – automate payment posting using the 835/ERA or continue with your existing paper process using our EOB printing options

• Print either a single consolidated file (less paper) containing all EOBs for a given deposit or print individual EOBs to submit to other carriers for your
secondary claim submissions

• EOBs are available for 13 months and can be downloaded as PDF files to store on your own system

• Reduced risk of lost, misrouted and stolen checks

• Potential elimination of bank lockbox fees

• Practice management software and technical expertise are NOT required.

• You can post payments the same way you do today



EPS with direct deposit:


• No credit card processing fees

• While funds are deposited to your account, UnitedHealthcare will not debit or deduct claim adjustments from your checking or savings account. You can also contact
your bank to ensure that you have appropriately placed controls over the electronic funds transfers to and from your account.

EPS with Virtual Card Payments:

• Virtual Card Payments can be processed using the same method leveraged by your organization to process credit card transactions. Please note, your current credit card processing fees will apply. Please confirm those rates with your bank of choice directly.[2]

• Banking information is not shared outside your organization.

Interest, late and overpayment of Medicare

Interest on Late Payment of Claims

The late payment on a complete HMO, POS, AIM, Healthy Families Program, or Medi-Cal claim for emergency room (ER) services that is neither contested nor denied automatically includes the greater of $15 for each 12-month period or portion thereof on a non-prorated basis, or interest at 15 percent per year for the period of time that the payment is late.
Late payments on all other complete HMO, POS, AIM, and Healthy Families Program claims that are neither contested nor denied automatically include interest at the rate of 15 percent per year for the period of time that the payment is late.
If Health Net does not automatically include the interest fee with a late-paid complete HMO, POS, AIM, Healthy Families Program, or Medi-Cal claim, an additional $10 is sent to the provider of service.
The late payment on a complete PPO, EPO or Flex Net claim for ER services that is neither contested nor denied automatically includes the greater of $15 per year or interest at the rate of 10 percent per year beginning with the first calendar day after the 30-working-day period.
Late payments on all other complete PPO, EPO or Flex Net claims that are neither contested nor denied automatically include interest at the rate of 10 percent per year beginning with the first calendar day after the 30-working-day period subject to exceptions pursuant to applicable state law including fraud, misrepresentation, eligibility determinations, or instances in which the carrier has not been granted reasonable access to information under a provider's control.
If Health Net fails to notify the provider of service in writing of a denied or contested claim, or portion thereof, and ultimately pays the claim in whole or in part, computation of the interest begins on the first calendar day after the applicable time period for denying or contesting claims has expired.

Overpayment of Claims

If Health Net determines that an overpayment has occurred, Health Net notifies the provider of service in writing within 365 days of the date of payment on the overpaid claim through a separate notice that includes the following information:
•    Member name
•    Claim ID number
•    Date of service
•    Clear explanation of why Health Net believes the claim was overpaid
•    The amount of overpayment, including interest and penalties

The 365-day time period does not apply to overpayments caused in whole or in part by fraud or misrepresentation on the part of the provider.

The provider of service has 30 working days to submit a written dispute to Health Net if the provider does not believe an overpayment has occurred. In this case, Health Net treats the claim overpayment issue as a provider dispute.
If the provider does not dispute the overpayment, the provider of service must reimburse Health Net within 30 working days from the receipt of Health Net's notice or, as permitted by law, interest begins to accrue at the rate of 10 percent per year beginning with the first day after the 30-working-day period.
Health Net may recoup uncontested overpayments by offsetting overpayments from payments for a provider's current claims for services as permitted under the Fair Claims Settlement Practices Regulations (in section 2695.11 of title 10, of the California Code of Regulations (CCR)).
A written notification is sent to the provider of service if an overpayment is recouped through offsets to claim payments. The notification identifies the specific overpayment and the claim ID number.

Global payment, professional and technical payment

Fee. The payment value for the medical procedure or item contained in 114.3 CMR 40.06 and identified by a Code. Fees may be listed as Professional Component Fee ("PC Fee"), Technical Component Fee (“TC Fee”) and Global Fee ("GL Fee") when a professional, technical or global fee applies. Single payment rates are listed as "Fees". See definitions of (GL), (PC) and (TC) below.

Global payment (GL). The Global Fee is the sum of the PC Fee and TC Fee. See definitions of (PC) and (TC) below

Professional Component payment (PC). Certain procedures are a combination of a physician, or professional component and a technical component. When the modifier –26 is added to an appropriate code a PC allowable amount shall be paid..

Technical Component payment (TC). The TC component reflects the technical portion of the radiology, laboratory, medical, or surgical procedure code. When the technical component is provided by a health care provider other than the physician providing the professional component, the health care provider bills for the technical component by adding Modifier –TC to the applicable code. The TC rate is payment for the facility’s cost of rent, equipment, utilities, supplies, administrative and technical salaries and benefits, and all other overhead expenses.