A series of projects have been completed with the goal of reducing
the amount of paper providers send to health plans, thereby reducing
staff time and speeding payment.
» Submitting
Supporting Documentation
Standard Cover
Sheet
(.pdf | 69K | Rev 10.08 | 10/07)
Guideline
Document
(.pdf | 33K | Version 10.8 | 10/07)
» Submitting Corrected Claims
Standard Cover Sheet
(.pdf | 60k | Rev 3.6 | 1.30.07)
Submitting Corrected Claims Guidelines
(.pdf | 27k | Rev 10.08 | 10/07)
» Following-Up
on Processed Claims
Guideline
Document
(.pdf | 29K | Rev 5.0 | 10/07)
» Using Common Modifiers
Updated to include additional health plans and user defined reports. Supports correct billing when most common modifiers are used.
Guideline Document
(.pdf | 26K | Rev 10.08 | 10/07)
» Anesthesia
Coding & Billing CRNA Services
Guideline
Document
(.pdf | 23K | Rev 10.08 | 10/07)
» Getting
Claim Receipt and Status Information
Guideline
Document
(.pdf | 26K | Draft 10.08 | 10/07)
» Conditions for Splitting Claims
Updated to include additional health plans and user defined reports. Clarifies the eight most common conditions under which claims are split.
Guideline Document
(.pdf | 15K | Rev 8.0 | 4.15.04)
» Quicker Resolution of Payment
Responsibility for Injuries
Now a dynamic report based upon diagnosis code and selected health plans.
Guideline Document
(.pdf | 49K | Rev 10.08 | 10/07)
» Incorporate Explanation
of Benefits (EOB) Info on Electronic Claims
Handling
EOB Info Guidelines
(.pdf | 33K | Rev 10.08 | 10/07)
» Resubmission of Claims Electronically
Policy
Statement RE: No Paper Claims
(.pdf | 9K | Rev 3.2)
» Clinical Notes Do Not Need
to be Submitted for Emergency Room Visits
Policy
Statement RE: No Clinical Notes For ER
(.pdf | 9K | Rev 3.3)
» Patient Insurance Card Not
Required
Policy
Statement RE: No Insurance Card
(.pdf | 9K | Rev 3.2)
» How Health Plans Handle Under Payments & Over Payments
Common questions about how participating Health Plans handle Claims Adjustments are answered. Health Plans spell out their processes and timelines.
Guideline Document
(.pdf | 21K | Rev 5.0)
» CPT Codes that will NO LONGER Automatically Pend a Claim for an Attachment
Health Plans and Providers are reducing the number of attachments that are required to process claims. Participating health plans have agreed that the attached list of CPT codes will NO LONGER trigger an automatic pend for an attachment. (NOTE: Not all of the participating health plans were automatically pending claims billed with these codes to await an attachment, but one or more were previously doing so. Now, none of the participating health plans will automatically pend claims with CPT codes on the attached list.)
Providers who have put automated edits into place to submit attachments when billing with these CPT codes should review their edits and adjust accordingly. Provider should also encourage non-participating health plans to similarly relax their requirements for these CPT codes.
Download Codes
(.xls | 33K | 12.06)
