Provider Guide - the Culinary Health Fund

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
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