Florida Blue submitting secondary claim address

Filing the Medicare Cross-Over Claim

File the claim to your Medicare carrier for primary payment. Claim information will not be crossed over to the member’s supplement plan (the secondary payer) until after Medicare has processed the claim and released it from the Medicare payment hold. Medicare secondary claims will normally be electronically forwarded by GHI (the CMS vendor) directly to the member’s supplement Blue Plan for processing of the secondary benefits. Check the Medicare Remittance Notice to identify whether the claim was crossed over directly to the member’s Medicare supplement Blue Plan. If it did, you do not need to take further action. The paper remittance notice will state “Claim information forwarded to: (Name of secondary payer). “ The 835 (electronic remittance) record can also carry the secondary forwarding information.

You will receive payment or processing information from the member’s supplement plan after they receive the Medicare payment. Please allow 45 days from the Medicare payment date for the secondary claim (Medicare Supplement coverage) to process.

If the claim did not crossover electronically to the secondary payer (Medicare supplement plan), then file the claim to BCBSF with the Medicare Remittance Notice attached. Send the claim to:

Florida Blue P.O. Box 1798 Jacksonville, Florida 32231-0014

Do not send secondary claims directly to the member’s Blue Plan secondary payer.

Note: If more than one claim appears on the Medicare Remittance Notice, please indicate the specific claim you are filing.

Inquiries around Medicare Crossover Claims

Direct inquiries on secondary claims to Florida Blue unless the member’s Blue Plan have requested specific information from you on a particular claim. Inquiries received on secondary claims by BCBSF will be coordinated with the member’s Blue Plan for resolution.

Example: A provider received the primary Medicare payment. The Medicare Remittance Notice stated, “Claims information was forwarded to: (Name of secondary payer).” It has been 45 days since Medicare’s payment and no communication has been received from the member’s supplement plan. This should be sent to Florida Blue as an inquiry so the member’s Blue Plan can be contacted and a resolution made on the status of the secondary claim. Florida Blue will communicate the resolution back to the provider. 13

Healthchoice Medicaid HMO Timely filing limit and claim submission address

BILLING INFORMATION

Providers must bill on the CMS-1500. Claims can be submitted in any quantity and at any time within the filing limitation.

Filing Statutes: Claims must be received within 12 months of the date of service. The following statutes are in addition to the initial claim submission.

12 months from the date of the IMA-81 (Notice of Retro-eligibility)

120 days from the date of the Medicare EOB

60 days from the date of Third Party Liability EOB

60 days from the date of Maryland Medicaid Remittance Advice

The Program will not accept computer-generated reports from the provider’s office as proof of timely filing. The only documentation that will be accepted is a remittance advice, Medicare/Third-party EOB, IMA-81 (letter of retro-eligibility) and/or a returned date stamped claim from the Program.

Paper Claims Submission: Once a claim has been received, it may take 30 business days to process your claim. Invoices are processed on a weekly basis. Payments are issued weekly and mailed to provider’s pay-to address. All claims should be mailed to the following address:

Claims Processing

Department of Health and Mental Hygiene

P.O Box 1935

Baltimore, MD 21203

Electronic Claims Submission: Providers must submit claims in the ANSI ASC X12N 837P format, version 5010A. A signed Submitter Identification Form and Trading Partner Agreement must be submitted, as well as testing before transmitting such claims.

Humana claims , overpayment, appeal address - time limit

Claim and encounter addresses

To decrease administrative costs and improve cash flow, clinicians and facilities are encouraged to use electronic claim submission whenever possible.

When it is necessary to submit paper claims, you can use the addresses below. Please keep in mind, however, that the claim or encounter mailing address on the member’s identification card is always the most appropriate to use.

Valid National Provider Identifiers (NPIs) are required on all electronic claims and strongly encouraged on paper claims.

Paper claim and encounter submission addresses

Humana medical claims:

Humana Claims

P.O. Box 14601

Lexington, KY 40512-4601

HumanaDental® claims:

HumanaDental Claims

P.O. Box 14611

Lexington, KY 40512-4611

Humana encounters:

Humana Claims/Encounters

P.O. Box 14605

Lexington, KY 40512-4605

Claim overpayments:

Humana

P.O. Box 931655

Atlanta, GA 31193-1655

HumanaOne® claim submissions:

HumanaOne

P.O. Box 14635

Lexington, KY 40512-4635

Claims submission time frames

Health care providers are encouraged to take note of the following claims submission time frames:

Medicare Advantage: Claims must be submitted within one calendar year from the date of service.

Important update from PUP

ALL CMS PUP patient would be moved Medicare from June 1. We could submit the claim to Medicare and get paid See the below notice form PUP.

claim submission guideline form SHP

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.

Where do I submit claims to MediPass?

Where do I submit claims to MediPass? What is the claim address and can it be submitted electronically? 

 I have contacted different Medicaid provider phone numbers, but I have not received any response back.

Claims for recipients in MediPass are billed just like any other Medicaid claim. Please consult the appropriate billing handbook Florida Medicaid Provider Reimbursement Handbook, CMS-1500, Florida Medicaid Provider Reimbursement Handbook, UB-04; etc. Or contact Provider Support with the Medicaid Fiscal Agent.

You will find the contact information for the fiscal agent, HP Enterprise Services, at: https://portal.flmmis.com/FLPublic/Portals/0/StaticContent/Public/Training/032409%20Complete%20General%20Information.pdf . The claims addresses are in the center of the page. The Medicaid Area Office for your county can also assist.

Is the NPI# the authorization number for MediPass kids? I have some pediatricians who write their NPI# as authorization and others who put their Medicaid #.

No. The National Provider Identifier (NPI) number cannot be used to replace the MediPass authorization number. Providers who are not sure what to use as the MediPass authorization number should contact their Medicaid Area Office. NPI numbers are 10 digits while the MediPass authorization numbers will be 9 digits.

What Is TRICARE? 3 Regions of Tricare - phone number

TRICARE is the uniformed services* health care program for active duty service members and their families, retired service members and their dependents,  members of the National Guard and Reserve and their families, survivors, and

others who are eligible. TRICARE’s primary objective is to deliver a world-class health care benefit for all Military Health System (MHS) beneficiaries that ensures the highest level of patient satisfaction.

TRICARE brings together the health care resources of the uniformed services and networks of civilian health care professionals, institutions, pharmacies, and suppliers to provide access to high-quality health care services while maintaining

the capability to support military operations.

TRICARE is available worldwide. In the United States, TRICARE is divided into three separate regions—TRICARE North, TRICARE South, and TRICARE West. The TRICARE Overseas Program is administered as one overseas region

divided into three areas—TRICARE Eurasia- Africa, TRICARE Pacific, and TRICARE Latin America and Canada.

In the United States, TRICARE is managed jointly by the TRICARE Management Activity (TMA) and TRICARE Regional Offices. TMA has contracted with civilian managed care support contractors in the North, South, and West regions to assist TRICARE regional directors and military treatment facility (MTF) commanders in operating an integrated health care delivery system.

insurance claims submission and mailing checklist

Claims Submission Checklist
Introduction 

Use the following checklist before submitting a claim to the fiscal agent for reimbursement.

Checklist

* Is the form typed or printed in black ink?
*  Is the copy legible?
* Were instructions in the handbook followed? Some fields are not self explanatory or may be used for other purposes.
* Are the provider name(s) and number(s) entered?
* Is the claim signed and dated? Unsigned claims will be returned unprocessed.
* Are attachments required? Claims cannot be paid without the required attachments.
*  Is the P.O. Box number for submitting the claim correct?


Claims Mailing Checklist
Introduction The following checklist may be used when mailing claims to the fiscal agent for
reimbursement.

Checklist

* Enclose only one claim type per envelope. Claims and adjustment requests should be sent separately because they are processed separately by the fiscal agent.

List of insurance and IVR phone numbers

This is basically from Florida state.

Telephone Number

1 Medicare 1877-847-4992

2 RR Medicare 1877-288-7600

3 Medicaid 1800-289-7799 and 1800-239-7560

4 AARP 1800-523-5800

5 Aetna 1800-624-0756

6 UMR 1800-826-9781

7 Great West and Cigna baycare 1800-663-8081

8 Amerigroup 1800-454-3730

9 Molina Health 186-472-4585

10 Summit and Coventry 1800-847-3995

11 Sunshine State 166-796-0530

12 Golden Rule 1800-657-8205

13 BCBS 1800-727-2227

What we can do in IVR - What are information need to use IVR . Interactive voice response (IVR) system capabilities

The IVR system provides automated information on claims, benefits and more, 24 hours a day, seven days a week.

Call the number on the back of the member’s Humana identification card to reach the IVR system.

Information available through IVR system

You can obtain a variety of information by using the IVR system.

The system can:

Confirm member coverage and the date the coverage began.

Notify you if referrals are required by the member’s plan.

Give you the status of a referral request.

Provide the member’s deductible, copayment and coinsurance information.

Provide the member’s out-of-pocket and lifetime maximum information.

Retrieve claim status for specific members.

Retrieve claim status for all your claims on one or more days.

Initiate inpatient admission and non-HMO (health maintenance organization) outpatient preauthorization requests.

Provide preauthorization request status*, directing your call to a Humana customer care representative, if needed.

In addition, you can use the system to request that the following information be sent to you by fax:

Member eligibility information.

Claims status: 40 claims per page, organized in a remit format.

Referral documentation.

Preauthorization documentation.

*Available in most areas

The IVR system gives you the option of requesting help from a Humana customer care representative. Assistance is available Monday through Friday on the following topics:

Medical eligibility, benefits and claims status: 8 a.m. to 8 p.m. EST.

Dental eligibility, benefits and claims status: 8 a.m. to 8 p.m. EST.

Preauthorizations: 8 a.m. to 6 p.m. EST.

Financial recovery: 8 a.m. to 5 p.m. EST.

Information you will need to use IVR

Before calling the IVR system, make sure you have the following information handy:

Nine-digit tax ID number.

Nine-digit member ID number (listed on member's ID card).

Member's date of birth (mm/dd/yy).

Date of service in mm/dd/yyyy format (for specific options, such as claims or precertifications).

Your fax number (if a fax-back option is requested). Specific information to initiate a preauthorization, including the following: CPT-4 (five-digit) codes for procedures and surgeries; ICD-9 (three-, four- or five-digit) codes for diagnoses; CPT or HCPCS codes for outpatient procedures. 

Dont call Medicare toll free service line for claim status

Customer service representatives cannot provide claim status via the toll-free service line

Medicare guidelines, specifically, the Internet-only manual (IOM) Publication, 100-09 Chapter 6 Section 50.1 requires that providers call the interactive voice response system (IVR) to obtain claim status.  Service associates responding to calls via our toll-free service line are not allowed to provide claim status.  To do so would be in violation of Medicare service guidelines.

First Coast Service Options’ (First Coast’s) customer service representatives (CSRs) continue to receive a large volume of calls from providers asking for claim status.  In the majority of cases the calls are coming from entities representing Medicare providers.  Because many providers have chosen to outsource their claims monitoring activities, they may not be aware that the entities representing them are calling the toll-free CSR service line for status of claims instead of using the IVR.

When claim status calls are made to the toll-free CSR service line, it slows our response time for other calls coming into our call center because service associates are attempting to explain to customers that status cannot be released via the general inquiry service line.  It is the responsibility of Medicare providers to notify the entities representing them that claim status inquiries must be made via the IVR or our new Internet portal the SPOT. See http://medicare.fcso.com/Landing/256747.asp.