![]() You will receive notification in writing if the appeal is denied. If you do not submit the appeal in the required time frame, CareSource will not reconsider the claim, and the appeal will be denied. If you do not agree with a denial on a processed claim, you have 365 calendar days from the date of service or discharge, unless otherwise specified in your contract, to submit an appeal. If the decision is to uphold the original claim adjudication, you may appeal the claim adjudication if timely filing rights still apply. Provider disputes for issues that are contractual or non-clinical should be sent to:ĬareSource will render a claim dispute decision letter within 30 calendar days of receipt. The request must be resubmitted with all necessary information within 90 calendar days of the claim payment or 10 calendar days of the date on the letter notifying you of the incomplete request.Ĭlaim disputes can be submitted to CareSource through the following methods: ![]() Incomplete requests will be returned with no action taken. Pertinent document to support the adjustment.A statement of why you believe a claim adjustment is needed.Sufficient information to identify the claim(s) in dispute.The dispute must be submitted within 90 calendar days of the date of payment. A request for review of a claim denial should be submitted as an appeal.Ĭlaim disputes must be submitted in writing. You do not need to submit an appeal for this type of review. Requests for adjustment for underpayment or overpayment may be submitted through the claim dispute process. Refer to the Claims page or the Provider Manual for further information related to corrected claims submission. You do not need to file a dispute or appeal. The claim form should have the words “see attachment” in the “Member ID” box.If you believe a claim was processed incorrectly due to incomplete, incorrect or unclear information on the claim, you should submit a corrected claim. Physicians and health care providers may submit CMS 1500 forms or UB04 forms with an attachment listing multiple patients receiving the same service. Physicians and health care providers may submit multiple documents in a single large envelope.ĭocuments may include information regarding multiple patients. Physicians and other health care providers should follow the billing guidelines below when submitting roster bills to Humana: When a claim is submitted in error to a carrier or agency other than Humana, the timely filing period begins as of the date the provider was notified of the error by the other carrier or agency.īilling guidelines for roster bills submitted on paper claims Generally, these claims must be submitted within:ġ80 days from the date of service for physicians.ĩ0 days from the date of service for facilities and ancillary providers. Medicare Advantage: Claims must be submitted within one calendar year from the date of service.Ĭommercial: Claims must be submitted within the time stipulated in the provider agreement or the applicable state law. ![]() Health care providers are encouraged to take note of the following claims submission time frames: Paper claim and encounter submission addresses Valid National Provider Identifiers (NPIs) are required on all electronic claims and strongly encouraged on paper claims. Please keep in mind, however, that the claim or encounter mailing address on the member’s identification card is always the most appropriate to use. When it is necessary to submit paper claims, you can use the addresses below. To decrease administrative costs and improve cash flow, clinicians and facilities are encouraged to use electronic claim submission whenever possible.
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