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) | Enrollment required |
| 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
- Payer ID
25169 - Payer ID
4569 - Payer ID
8472 - Payer ID
GATHP - Payer ID
GHPMCD - Also listed as Gateway Health Plan Medicaid Pennsylvania
Enrollment requirements
- Electronic remittance (ERA 835): one click enrollment, typically takes weeks
Workflow for this payer
- Run a 270/271 eligibility and benefits inquiry before visits when possible, but use another approved workflow for coordination-of-benefits needs.
- Submit professional claims as 837P and institutional claims as 837I, then use 276/277 to check claim status.
- Complete payer enrollment before relying on ERA 835; until enrollment is active, maintain a manual or otherwise approved remittance workflow.
- Do not route 837D dental claims, 275 attachments, EFT, or combined ERA and EFT through this connection.
Common questions
Which claim types can I submit electronically?
Professional claims (837P) and institutional claims (837I) are supported. Dental claims (837D) are not available through this connection.
Is ERA available for this payer?
Yes, ERA (835) is supported after the practice completes payer enrollment. Until enrollment is complete, do not expect remittance files through the electronic connection.
How can I check eligibility and claim status?
Use 270/271 for eligibility and benefits and 276/277 for claim status. Coordination-of-benefits (271) transactions are not available, so handle that need through another approved process.
Does this payer support EFT or attachments?
EFT, ERA and EFT combined, and attachments (275) are not available through this connection. Plan payment and attachment workflows separately, using an approved route.
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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