Claims
& Payment Information
Manage your claims status inquiries, disputes, and non-covered services all in one place.
Claims Status Inquiries
Check the status of your submitted claims
Provider Web Portal
All claims status inquiries must be made via our Provider Web Portal. If you don't have a portal account with EMI, you can submit your request using our online form.
No Internet Access?
You may also make any claims status inquiries telephonically at one of the numbers below:
Claims Disputes
Contest claim payments or reductions in reimbursement
Important: 60-Day Deadline
If a provider wishes to contest any claim payment or reduction in reimbursement for specific procedures, the following actions must be taken within 60 days after receipt of the provider remittance or Explanation of Payment (EOP). Disputes submitted after 60 days will not be considered.
Complete the Claims Review/Dispute Form
Download and fill out the official Claims Review/Dispute Form with all required information about the contested claim.
Download Claims Review/Dispute FormAttach All Pertinent Documentation
Include all relevant supporting documents that substantiate your dispute.
Submit Copies of Original Claim & EOP
Include a copy of the original claim (marked "COPY") and a copy of the Explanation of Payment (EOP) which accompanied the original claim.
Mail All Information
Important: Do not call the office, fax information, or direct the information to any other department.
Response Timeline
All attempts will be made to answer your response within thirty business days or sooner. However, at times, a claims dispute may be forwarded to the Peer Review Sub-Committee in which case you will be notified of this action, and the time expected before a response will be forthcoming.
Submission Deadline Reminder
Dispute must be submitted within 60 days of receipt of the EMI EOP. Receipt of dispute after 60 days will not be considered.
Non-Covered Vision Services
Information about services not covered by member benefit packages
Covered benefits by EMI ophthalmologists vary according to the member's health plan. Refer to the applicable health plan section of the Procedure Manual in the Index under "Non-Covered Services".
In the event that a member requests that your office perform a non-covered vision service, EMI has provided you with the Vision Fee Information form.
Vision Fee Information Form
This form explains to the member that the services you are providing are not covered under their benefit package and they are responsible in full for the cost of any non-covered services provided by you.
Member Notification
The member must be adequately informed prior to receiving non-covered vision services that they will be responsible for the payment of such services.
Written Consent Required
In addition to written consent by the member, EMI must be notified in advance and give written approval to charge the member for these services.
Form Signature Required
This form must be signed each time a non-covered vision service is provided.
Need the Vision Fee Information Form?
Download the form to inform members about non-covered services
Download Form