We offer benefit/eligibility verification in three ways:

1. Save yourself a telephone call by submitting a request to your billing clearinghouse for Heraya claim status or Heraya member eligibility electronically. Heraya will then send an electronic response to your billing clearinghouse within the timeframes noted below:
   1. One inquiry (real-time request) – Heraya will electronically respond in 20 seconds or less.
   2. More than one inquiry (batch request) – Heraya will electronically respond by the next business days, but no more than 10 hours.
2. Our Provider Billing Manual contains the phone numbers to call to verify benefits for each line of business.
3. The Heraya Patient Eligibility Verification Form is available on the Frequently Used Form page and in our billing manual. Complete it, fax to us, and we will respond to within two (2) business days of receipt.

Yes, Heraya is contracted with Office Ally and HealthSmart to accept electronic claims. You may send claims directly through these entities. If you use another vendor, check to see if they can route your claims to Heraya through these entities.

• Office Ally – Heraya’s Payer ID is Heraya01
• HealthSmart Information Systems.- Heraya’s “Payer ID” is 93101

Heraya accepts electronic claims only.

The Heraya Provider Billing Manual outlines where to send claims for each line of business and includes telephone numbers to verify eligibility.

Kaiser Permanente processes claims for PCP-referred patients. As outlined in our Billing Manual, please mail these claims directly to Kaiser at Kaiser Permanente, 500 NE Multnomah Ave. #100, Portland, OR 97232-2099. If you have questions about a PCP-referred patient or their claims, contact the KP Community Medicine Integration Center directly at 503‐813‐3437.

Claims paid by Heraya typically have a 60-day timely filing period. Timely filing periods can vary by the lines of business. Please refer to our Provider Billing Manual for the timely filing period for each line of business.

Heraya allows our providers 30 days from the date of Heraya’s Remittance Advice (RA) denial to resubmit the claim to Heraya. Examples of reasons for resubmissions include claims denied due to a billing error or a request for clinical records. When resubmitting claims electronically, enter “7” in Field 22. This code indicates the claim is a corrected claim or resubmission.

Heraya providers have 30 days from the date on the other carrier’s Remittance Advice (RA) denial or Explanation of Benefits (EOB) denial to resubmit the claim to Heraya. Be sure to include a copy of the other carrier’s RA or EOB when you submit your claim to Heraya.

Providers who are contracted with Heraya for more than one specialty should submit separate claims for each specialty. For example, a provider who treats a member on one date of service and is contracted as both a naturopathic physician and an acupuncturist should submit one claim for naturopathic services and a separate claim for acupuncture services. Both claims should include the proper credentials (ND or LAc) in Field 31 attached to the rendering physician’s name. A co-payment for each discipline should be collected from your patient.

Refer to the laboratory formularies and/or fee schedules supplied to the Heraya provider at the time of contracting or amendment. For claims processed by Heraya, our Billing Manual contains a list of current Heraya contracted facilities. If there is not a contracted facility in your area, please see the Contracted Facilities section in the Billing Manual for further instructions.

If you have new information or a clarification of information that was not available with the original claim, you may request a reconsideration. Please refer to the Heraya Provider Billing Manual which contains the Claims Reconsideration Process and the Request for Claims Reconsideration Form. This information should be received by Heraya within 30 days of Heraya’s Remittance Advice denial date.

We have one easy form to sign up for both EFT and/or ERA! It is on the Frequently Used Forms page. Be sure to attach a copy of a voided check if you are signing up for EFT.

Heraya’s most current Billing Manual is on the Manuals and Policies Page.

Heraya Claims Representatives are available via telephone Monday through Friday, 8 am to 5 pm, Pacific Time (except for observed holidays and department meetings).

Phone: 503-203-8333 or 800-449-9479
Claim Fax: 503-203-8522