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

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Secondary Claims Submission • Secondary Claims Submission (Third Party Liability) must be submitted via Paper Claims; UB-92 or CMS- 1500. • Copy of the Primary Payer’s EOB / Remittance must be submitted with the Claim Form (Do not staple to the claim form) • Community Care reimburses only those dollars identified as ‘Patient Responsibility” on the Primary Payer's EOB / Remittance. (Co-Pay, Deductible etc.) 32
Corrected Claims • Corrected UB-92 claims can be submitted via EDI or Provider Online by utilizing the correct Bill Type. • Corrected CMS-1500 claims must be submitted in paper. • Corrected claims must be submitted anytime a ‘Critical’ component of a claim is to be changed. • A copy of the original claim with “Corrected Claim” written on the top of the form. • Draw a line through the incorrect information and write the correct information directly on the form. 33
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 and 10: Electronic Claims Submission Provid
Page 11 and 12: Critical Claim Elements Critical De
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: Initial Claims Submission Provider
Page 35 and 36: Provider Facts What Diagnosis / Ser
Page 37 and 38: Reminders • The North Central Pre

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

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