Provider Guide - the Culinary Health Fund

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Provider Guide October 2012 Claims Processing Guidelines The Culinary Health Fund uses a Third Party Administrator, Zenith American Solutions to process all claims. Claims Submission The Culinary Health Fund accepts claims via electronic submission. Providers interested in submitting claims electronically should contact one of the following clearinghouses to set up an account: Capario (ProxyMed) 800-586-6938 The SSI Group, Inc. 800-880-3032 HCRNet 702-735-5525 Emdeon 800-845-6592 Our Electronic ID is 59140 Paper claims should be submitted to: Zenith American Solutions P.O. Box 94469 Seattle WA 98124 All claims submitted to Zenith American Solutions go through an Optical Character Recognition process, which turns the paper claim into a scanned image. This process allows Zenith American Solutions to process claims faster. In order to ensure that this process can take place, please be sure to follow the guidelines below: • Claims submitted should be the finest quality, using the standardized Red CMS 1500 (08/05) forms. • All information should be typed, as handwritten forms cannot be Scanned into this system. • The ink should be dark (if it is too light it will not be processed). Information must be properly aligned on the claims form. Electronic Funds Transfer The Culinary Health Fund has teamed up with Pay Span Health and offers the providers Electronic Fund Transfers (EFTs). This service enables online presentation of Explanation of Payment (EOP), direct deposit into a designated bank account and straightforward reconciliation of payments to empower our providers to reduce costs, speed secondary billings, improve cash flow and help the environment by reducing paper usage. To find out more information on how to become registered for this new service, please contact Pay Span Health at 877-331-7154. 22 Culinary Health Fund Administrative Services, LLC
October 2012 Provider Guide Claims Processing Guidelines Allowable Requests Requests for allowables should be faxed to Provider Services at 702-892-7326. Providers may also refer to the reimbursement page of their current provider agreement to obtain payment methodology for reimbursement rates. Timely Filing There is a 90-day filing limit to submit new claims to the Culinary Health Fund. It is the provider’s responsibility to ensure claims are received within the 90-day filing limit. Secondary claims must be submitted within 90 days of the primary EOB. Claims Status Please allow at least 30 days from the date of submission before inquiring about claims status. Claims status can be checked on the Culinary Health Fund’s website at www.culinaryhealthfund.org, or by utilizing the IVR telephone system at 702-733-9938, option 1, or by contacting the Customer Service Office at 702-733-9938. • From time to time, claims are pended for additional information such as accident/injury inquiries and coordination of benefit information. In these cases, in order to ensure claims are not delayed, it is important to send any relevant information regarding the claim, such as the chart notes or injury forms. • Injury/subrogation and coordination of benefit forms can be requested from the Customer Service Office at 702-733-9938 or printed from our website at www.culinaryhealthfund.org. Provider Reconsiderations In an effort to expedite the administrative process for providers seeking to appeal a decision on a claim, the Culinary Health Fund has established a Provider Reconsiderations Department. You may contact Provider Reconsiderations at 702-691-5625 / FAX: 702-216-9525 or mail your reconsiderations directly to the following address: Provider Reconsiderations Culinary Health Fund P. O. Box 44216 Las Vegas, NV 89116 To submit a corrected claim, please clearly indicate on the claim that it is a corrected claim. This will avoid the claim being denied as a duplicate. If you feel the claim was submitted correctly and you wish to appeal, please send a copy of the EOB and an appeal letter, or a Provider Reconsiderations Form. You can find a copy of the Provider Reconsiderations Form in the back of this guide or on our website at www.culinaryhealthfund.org. Please allow 60 days from date of submission for review. Please Note: First level provider reconsiderations must be received within 180 days of the date on the initial explanation of payment. Second level reconsiderations must be received within 30 days of the processing date of the first level appeal, which can be found on the explanation of payment. Culinary Health Fund Administrative Services, LLC 23
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Provider Guide - the Culinary Health Fund

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