Is there a difference in the standards between paper claims and EDI claims?
No, there is no difference as far as the DOL regulation is concerned. It does make a difference to First Health, however, in the determination of when we received the claim and, thus, when the time frame for processing begins. For those clients who use our network services but for whom we do not perform claims administration, we will work on your behalf with your claims administrator to meet the DOL time frames. Our standard for turnaround time of EDI claims is 95% in 24 hours and 99% within 72 hours. For paper claims, our turnaround time standard is 95% within two calendar days and 99% within five calendar days.
