North Central Counties Introduction to Community Care's Claims ...

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Paper Claims Submission Paper Claim Forms can be submitted on the following: UB-92 • Inpatient, hospital based services • Residential Treatment Facility – JCAHO accredited CMS-1500 (previously known as HCFA-1500) • All ambulatory levels of care • Non Hospital, Residential levels of care • Residential Treatment Facility – Non JCAHO 10
Critical Claim Elements Critical Details on a UB-92 • Box 1 Name & Address of Physician, Clinician or Facility named on the Authorization Report for the service. • Box 3 Provider’s Invoice Number • Box 4 Type of Bill • Box 5 Federal Tax ID Number. It must be associated with the Vendor information on your Community Care contract. 11
Page 1 and 2: North Central Counties Introduction
Page 3 and 4: General Claim Information Claims Of
Page 5 and 6: General Claim Information Our Inten
Page 7 and 8: North Central Timely Filing Standar
Page 9: Electronic Claims Submission Provid
Page 13 and 14: Critical Claim Elements (cont.) Cri
Page 21 and 22: Critical Claim Elements (cont’) C
Page 27 and 28: Critical for Correct Payment • Me
Page 29 and 30: Initial Claims Submission - Paper
Page 31 and 32: Initial Claims Submission Provider
Page 33 and 34: Corrected Claims • Corrected UB-9
Page 35 and 36: Provider Facts What Diagnosis / Ser
Page 37 and 38: Reminders • The North Central Pre

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