BeneStreet provides a digital technology platform that makes it easy for employer groups with less than 100 employees, via their TPAs to:

Seamlessly integrate billing as medical claims that can be auto adjudicated through the employer’s TPA, and

Facilitate traditional check-based payments through the employer’s health plan fund account.

This Billing Implementation Guide is designed to simplify the process into three required steps:

1. Setup TPA’s claims processing system to electronically receive claims for BeneStreet

2. Provide SFTP instructions/connectivity for direct EDI submissions by BeneStreet

3. Setup traditional check-based payments to BeneStreet

TPA Claims Processing Setup

1. Add BeneWize to their system as an “in-network / non-contracted” provider:

Option A - Some TPAs find it more scalable to create a “custom network” in their system, in which BeneStreet is the only “provider” within this custom network. Then this “custom network” can be added to any client as needed.
Option B – Other TPAs simply add BeneStreet as a “provider” and then add BeneStreet to any client as needed.

* These options are usually chosen based on the TPA’s technology system abilities / limitations, and/or corporate preference.

** See details below for NPI number.

2. TPA to confirm the existence of the following HCPCS S Code in their system:

S9446 – Patient education, not otherwise classified, non-physician provider, individual, per session.

3. TPA will need to set the following rules to pay claims received from BeneStreet:

Billed amount = paid amount
A limit of $2.50 USD PEPM will be the allowable amount for any of the claims submitted by BeneStreet.
No prior authorization required

BeneStreet Submission Process

BeneStreet will aggregate all employees of a single group/client into a single 837P submission.
TPA will provide BeneStreet with an SFTP site for the submission of 837 claims files. Since the eligibility file is being sent by the TPA prior to BeneStreet sending the 837, a 270-eligibility inquiry and a 271-eligibility response will not be necessary.
BeneStreet will simultaneously notify the TPA via email of the submitted files. TPA will need to provide contact information on who should receive email notification.

Traditional Check-Based Payment Setup

For all employer groups with less than 100 employees, BeneStreet requests payments be aggregated into a single traditional check payment.

BeneStreet requests either an 837 remittance advice or an email notification be sent to BeneStreet advising the number of payments and the corresponding amounts.
TPA will transmit payments for all claims to their check-based vendor for mailing to BeneStreet at the location provided below.