Claims Processing Policies & Guidelines

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 Corrected Claims

Corrected Claims Cover Sheet   Fields on form can be typed for clarity before printing.
(.pdf | 64k | Rev 3.5| 5/2011)

Corrected Claims Guideline Document
(.pdf | 135k | Rev 4.2 | 5/2011)

» Submitting Supporting Documentation

Supporting Documentation Cover Sheet    Fields on form can be typed for clarity before printing.
(.pdf | 69K | Rev 10.08 | 10/07)

Supporting Documentation Guideline Document
(.pdf | 33K | Version 10.8 | 10/07) 


» Conditions for Splitting Claims
        Clarifies the eight most common conditions under which claims are split.

Guideline Document
(.pdf | 11.26.13)


» Following-Up on Processed Claims -- No Longer Applicable


» Using Common Modifiers  -- No Longer Applicable

» Anesthesia Coding & Billing CRNA Services  -- No Longer Applicable


» Getting Claim Receipt and Status Information -- No Longer Applicable


» Clinical Notes Do Not Need to be Submitted for Emergency Room Visits  -- No Longer Applicable


» Patient Insurance Card Not Required  -- No Longer Applicable