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Best Practices for Health Plans that Sub-Contract Creation of the Remittance Advice

September 29, 2022

Providers are experiencing challenges in situations where they have a relationship/contract with a specific health plan (and submit their claims to that health plan), but that health plan then sub- contracts some or all services to a business associate - another health plan or vendor.

This paper will discuss the challenges related to remittance advice information related to this situation. Challenges related to the payment of these claims may be addressed in a future version of the Electronic Payments Guiding Principles paper.

This paper specifically addresses issues occurring with in-network providers, but these challenges may apply to out of network providers as well.

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