Claims Submission
Claims are to be submitted to Simply Healthcare Plans with appropriate
documentation by mail or filed electronically for CMS-1500 and UB-04 claims.
For those members that may be assigned to a delegated medical group/IPA that
does its own claims processing, please verify the “Remit To” address on the SHP
Member ID Card. Providers billing SHP directly should submit claims to:
Simply Healthcare Plans, Inc.
Attn: Claims
PO BOX 21535
Eagan, MN 55121
Providers are expected to use good faith effort when billing SHP for services
by using the most current coding (ICD-9, CPH, HCPCS, etc.) available. The
following information is to be included on all claims submissions, electronic
or paper:
3. Member’s name, date of birth, sex and ID number
4. Date(s) of service, place of service(s) and number of days or units, if
applicable
5. Provider tax identification and NPI number
6. ICD-9 diagnosis codes by specific service to the highest level of
specificity
7. Current CPT, revenue and HCPCS procedure code(s) with modifiers is
appropriate
8. Billed charges per service(s) provided and total charges
9. Provider name and address, signature, and phone number
10. Information about other insurance coverage, Workers’ Compensation, accident
or auto information, if available
11. Attach a detail description of the service or procedure for claim submitted
with unlisted medical or surgical CPT or other revenue codes
12. For resubmissions and corrections of a claim, please submit a new CMS 1500
or UB-40 indicating the correction.
