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Submitting a Claim in Hard Copy Format

 

CMS-1500 Claims Submission

Effective 1/1/2015, all participating providers must submit their claims electronically. All paper claim submissions from participating providers will be denied. 

HealthPlus also strongly encourages all non-participating providers to  submit claims electronically.

HealthPlus utilizes electronic claims scanning technology to process paper claims. When a claim is received in hard copy, the form is scanned and saved as an electronic file.

Providers submitting hard copy claims must use the original CMS-1500 (02-12) claim form. Copies are not accepted. Refer to CMS-1500 Form Locator Requirements for information on completing the CMS-1500 Claim form.

You must follow the requirements listed below to ensure prompt processing of your claims. Incomplete or erroneous claims will be returned to the provider for completion and/or correction.

  • Use the original CMS-1500 form ONLY; enter information in the non-red shaded areas ONLY.
  • All claims must be typewritten or computer-generated in a dark print; do not submit handwritten claims.
  • All data must be contained within each locator box, left justified.
  • Use the patient’s 11-digit contract number (9-digit contract number plus suffix.)
  • Do not enter more than six service lines per claim. Do not enter two service lines into one space.
  • The procedure code is sufficient; do not type the description.
  • Use your National Provider Identifier (NPI) number in form locator box 33a, not your tax identification number. If you do not include the NPI number, claims payment may be delayed or denied and/or your claim may be returned to you for resubmission.
  • The National Provider Identifier (NPI) number of the rendering practitioner needs to be in form locator box 24j.
  • Be sure to enter other health benefit plan information (Coordination of Benefits) in form locator box 9.

UB-04 Claims Submission

Effective 1/1/2015, all participating providers must submit their claims electronically. All paper claim submissions from participating providers will be denied. 

HealthPlus strongly encourages all non-participating providers to also submit claims electronically.

HealthPlus accepts institutional claims using the UB-04 Claim form. The UB-04 Manual provides a complete description of the definition, purpose, billing requirements, and instructions for each form locator on the UB-04 claim form.

Mail Hard copy CMS 1500 and UB 04 claims to:
HealthPlus of Michigan
PO Box 1700
Flint, MI 48501-1700

For questions related to submitting a hard copy/paper claim contact the Customer Service Department at (800) 332-9161.

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