Providers
Frequently Asked Questions
How do I contact EGA?
For claims submissions, please check the member's ID card for the specific submission address. Certain PPO claims must be sent to the repricing address prior to processing by EGA.
Claims status and eligibility information requests for EGA and Significa Insurance Group should be submitted electronically via Emdeon. You will find additional information about Emdeon on our Provider page.
| Address: | EGA, Inc.
P.O. Box 7777
1871 Santa Barbara Drive
Lancaster, PA 17604-7777 |
| Office Hours: | 8:30 a.m. to 4:30 p.m. |
| Phone: | (800) 433-3746 or (717) 581-1300 |
| Fax: | (717) 581-8379 |
| Email: | customerservice@ega-inc.com |
Why are some claims sent directly to EGA and others to alternate addresses?
The claims submission address (typically found on the back of the member's ID card) is determined by who performs the PPO repricing. For PPO repricing that is performed by EGA, the claims can be sent directly. For PPOs that perform their own repricing, the claim must be submitted first to the repricing address as it appears on the member's ID card.
Is precertification required? And, if so, what number do I call?
Precertification may be required for certain services, such as inpatient hospital admissions. The precertification telephone number is listed on the reverse side of the member's ID card.
Does precertification guarantee payment of the claim?
No. Precertification is a provision of the plan that reviews medical necessity and appropriateness as well as standards of care and utilization/service levels. A service can be medically necessary and appropriate and still not be an eligible expense under the plan.
If you need to determine if a high cost procedure is eligible under the plan, submit a request in writing to EGA. Your request will be reviewed promptly and a written response will follow.
Why is it important to keep EGA informed of any changes to my W-9 information?
A delay in claims payment will result if EGA does not have your latest W-9 information on file. If you are a new provider or if your practice has experienced business changes, please contact EGA's accounting department by calling (717) 581-1300 or (800) 433-3746 or faxing (717) 581-1319.