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)
Supporting Documentation Cover
Sheet Fields on form can be typed for clarity before printing.
(.pdf | 69K | Rev 10.08 | 10/07)
Supporting Documentation Guideline
(.pdf | 33K | Version 10.8 | 10/07)
on Processed Claims
(.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.
(.pdf | 26K | Rev 10.08 | 10/07)
Coding & Billing CRNA Services
(.pdf | 23K | Rev 10.08 | 10/07)
Claim Receipt and Status Information
(.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.
(.pdf | 15K | Rev 8.1 | 4.15.04)
» Quicker Resolution of Payment
Responsibility for Injuries
Now a dynamic report based upon diagnosis code and selected health plans.
(.pdf | 49K | Rev 10.08 | 10/07)
» Incorporate Explanation
of Benefits (EOB) Info on Electronic Claims
EOB Info Guidelines
(.pdf | 33K | Rev 10.08 | 10/07)
» Resubmission of Claims Electronically
Statement RE: No Paper Claims
(.pdf | 9K | Rev 3.2)
» Clinical Notes Do Not Need
to be Submitted for Emergency Room Visits
Statement RE: No Clinical Notes For ER
(.pdf | 9K | Rev 3.3)
» Patient Insurance Card Not
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.
(.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.
(.xls | 33K | 12.06)