What To Know About Empire Claims

What Is An Empire Claim?

 

Simply put, a claim is what a doctor submits to Empire so they receive payment. It shows the medical services that were provided to you. We’ll take the claim, or bill, and pay our part. Sometimes, you’ll owe a part of the bill as well. We’ll let you know based on what your plan covers.

How To Submit An Empire Claim Yourself

 

Typically, your doctor or provider, especially if they’re in your plan, will submit the claim for you. In some cases when you visit a doctor outside your plan, you may have to do this yourself. You can access claim forms in our Forms Library.

 

Here are some steps to make sure your claim is processed smoothly:

  • Make sure the claim form from your benefits plan includes all required information, especially procedure codes (you can receive these from your doctor’s office).
  • If you’re filling the form out by hand, write legibly.
  • File your paperwork promptly and within the time limit.
  • Include preapproval (if needed).

 

How Does Empire Claims Processing Work?

 

After your visit, your doctor sends a bill to Empire for the care you received during your visit. Or you can submit a claim for the services you received. 

 

  • A claims processor will check the claim for completeness, accuracy, and whether the service is covered by your plan. 
  • If the service is covered by your plan, Empire pays the claims – sometimes the entire cost or a portion is paid depending on your benefits. You’ll be responsible for paying any remaining portion. 
  • The claims processor also verifies important information like your copay and how much of your annual deductible and out-of-pocket maximum you’ve already paid.

 

What Happens After Your Empire Claim Is Processed?

 

After we complete our review of your claim, you’ll receive an Explanation of Benefits (EOB) showing what we paid, and what you owe. Log in to your member account to view your claims and EOBs.

 

Can You Access Empire Claims From Your Phone?

 

You can view claims anytime from your phone by downloading the Empire SydneySM Health app.

 

What Empire Members Have Access To Claims?

 

Individual And Family Members

 

Whether you are viewing a claim for yourself or a family member, you can review all claims at your Empire member account. Log in to your member account to access your claims information.

 

Medicare Members

 

Medicare members have the same easy access to claims by logging in to their account.

 

Employers

 

Employers can access claims forms by using Employer Forms Library.

 

Anthem Life

 

Members can submit life and disability claims at Anthem Life.