Notify TRICARE if there's a Third Party Involved Include that code with the description in Box 8a.Ĭlaims submitted without a signature will be denied payment. Your provider should give you a diagnosis code for all services he or she provided. Include the sponsor's Social Security Number or Department of Defense Benefits Number, your home address and phone number, as well as any other pertinent information needed. Update DEERS now!įile medical claims on a Patient's Request for Medical Payment (DD Form 2642). Incorrect information in DEERS could cause your TRICARE claim to be denied. Here are some tips to help you file your claims correctly: Keep DEERS Updated For information on prior approval, claims submission, and claims status please visit Beacon Health Options.Claims may be delayed or denied because the claim form wasn't filled out correctly or all the information wasn't provided. Lancaster, NY 14086 Behavioral Health Services Claimsīehavioral Health Services for HCP DIRECT EmblemHealth members are managed by Beacon Health Options. Physical and Occupational Therapy claims for all HCP DIRECT EmblemHealth members are handled by Palladian Physical and Occupational Therapy. You must file the appeal within 60 calendar days from the date of this explanation of payment. Out-of-Network Providers Submitting Medicare Advantage Claimsįor claims denials that resulted in partial or zero payment: You are only permitted to file a standard appeal for a denied Medicare Advantage claim if you complete a Waiver of Liability, which states that you will not bill the member regardless of the outcome of the appeal. Completed forms can be faxed to (516) 394-5693. Please download the Claims Reconsideration Request Form and follow the instructions. Claim ReconsiderationĪs a participating HCP provider, you may request Claim Reconsideration for any claim submission that you feel was not properly processed. Login credentials for EZ-Net are required. Use EZ-Net, HCPs secure web-based data exchange application, to view the status of an existing claim previously submitted to HCP. Where HCP is the secondary payor under Coordination of Benefits, the time period shall commence once the primary payor has paid or denied the claim. The timely filing for Medicaid, Medicare, and Commercial claims is within 120 days of the date of service. Highlighted areas can become fully obscured during the scanning process. All paper documents are scanned using light-sensitive equipment. Do not use colored highlighters on your claim forms.Failure to submit the most specific ICD-10 code(s) may result in the rejection of your claim. The Centers for Medicare and Medicaid Services (CMS) requires that ICD-10 codes be submitted at the highest level of specificity.Always include your Tax ID Number and NPI (National Provider Identification) number.Any missing or omitted information may lead to a delay in processing or rejection of your claim. Be sure to properly complete your claim form.Garden City, NY 11530 Helpful Tips for Successful Paper Claim Submission ALL HCP Direct paper claims must be faxed to (516) 515-8870 or mailed to: Retain copies of your EDI transmission acceptance reports as evidence of transmission.Īll paper claims for HCP Direct members must be submitted on a properly completed CMS 1500 or UB04 claim form.Mismatched patient information may result in the rejection of your claim. Verify that the Member’s first and last names, health plan ID, and date of birth match current eligibility records.Submit EDI claims with the Provider’s full and proper name and National Provider Identifier (NPI) number.Helpful Tips for Successful EDI Transmission HCP’s Payer ID number with Availity is 11328. For assistance, contact Availity at (800) 282-4548 To Submit HCP Direct Claims: In order to submit claims via EDI through Availity to HCP, you must first Log In or Register as necessary with the Availity Essentials Portal at. In addition, it provides you with a record of your claim upload. This process streamlines your claims, improves response time, and enhances correction capabilities. HCP’s preferred method of claims submission is electronic through Availity.
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