Supported electronic transactions
| Transaction | Status |
|---|---|
| Eligibility & benefits (270/271) | Supported |
| Claim status (276/277) | Supported |
| Professional claims (837P) | Supported |
| Institutional claims (837I) | Supported |
| Dental claims (837D) | Not supported |
| Electronic remittance (ERA 835) | Not supported |
| Electronic funds transfer (EFT) | Not supported |
| ERA + EFT combined | Not supported |
| Coordination of benefits (271) | Not supported |
| Attachments (275) | Not supported |
Other payer IDs and names
- Also listed as Brighton Health Plan Solutions
- Also listed as Create
Workflow considerations
- Send professional claims as 837P and institutional claims as 837I; do not use 837D for dental claims.
- Run 270/271 eligibility checks before visits, but handle coordination-of-benefits needs separately because COB transactions are not supported.
- Use 276/277 to follow submitted claim status instead of expecting remittance details from a status response.
- Build a separate workflow for remittance posting and payment reconciliation because ERA 835 and EFT are unavailable.
- If records are requested, follow this payer's accepted submission process; electronic attachments through 275 are unavailable.
Common questions
Which electronic claim formats does this payer accept?
Use 837P for professional claims and 837I for institutional claims. Dental claims in 837D are not supported.
Can I verify eligibility and check claim status electronically?
Yes. Use 270/271 for eligibility and benefits and 276/277 for claim status; these transactions are available immediately, while coordination-of-benefits transactions are not supported.
Does this payer support ERA or EFT?
No. ERA (835), EFT, and the combined ERA/EFT option are unavailable, so plan remittance and payment reconciliation through a separate process.
Can I send medical records or attachments electronically?
No, 275 attachments are not supported. Use this payer's stated alternative process when documentation is required.
Run this payer inside Hero EMR
Hero EMR submits claims, checks eligibility, and posts remittances automatically for the payers it connects to. The first physician is free.
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