The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), is currently used to code diagnostic information on claims. To ensure claims are as accurate as possible, use current valid diagnosis and procedure codes and code them to the highest level of specificity (maximum number of digits) available. National Uniform Billing Committee’s UB-04 Data Specifications Manual, is available at CODINGĬorrect coding is key to submitting valid claims. Health Net uses the National Uniform Billing Committee (NUBC) Official UB-04 Data Specifications Manual as the standard source for codes and code descriptions to be entered in the various form locators (FL). IMPORTANT NOTE: We require that all facility claims be billed on the UB-04 form. Medicare CMS-1500 and CMS-1450 completion and coding instructions, are available on the Centers for Medicare & Medicaid Services (CMS) website at All paper claims and supporting information must be submitted to:Ī complete claim is a claim, or portion of a claim that is submitted on a complete format adopted by the National Uniform Billing Committee and which includes attachments and supplemental information or documentation that provide reasonably relevant information or information necessary to determine payer liability. These claims will not be returned to the provider. The form must be completed in accordance with the National Uniform Billing Committee (NUBC) Official UB-04 Data Specifications Manual 2018 at Paper claims follow the same editing logic as electronic claims and will be rejected with a letter sent to the provider indicating the reason for rejection if non-compliant. Providers billing for institutional services must complete the CMS-1450 (UB-04) form. The form must be completed in accordance with the guidelines in the National Uniform Claim Committee (NUCC) 1500 Claim Form Reference Instruction Manual Version 5.0 7/17 at Paper claims follow the same editing logic as electronic claims and will be rejected with a letter sent to the provider indicating the reason for rejection if non-compliant. Providers billing for professional services and medical suppliers must complete the CMS-1500 (02/12) form. Providers should purchase these forms from a supplier of their choice. Health Net does not supply claim forms to providers. Copies of the form cannot be used for submission of claims, since a copy may not accurately replicate the scale and OCR color of the form. To reduce document handling time, providers must not use highlights, italics, bold text, or staples for multiple page submissions. Claims submitted on black and white, handwritten or nonstandard forms will be rejected and a letter will be sent to the provider indicating the reason for rejection. Paper claim forms must be typed in black ink with either 10 or 12 point Times New Roman font, and on the required original red and white version to ensure clean acceptance and processing. Health Net only accepts standard claim forms printed in Flint OCR Red, J6983 (or exact match) ink. Requirements for paper forms are described below. Refer to electronic claims submission for more information.įor providers unable to send claims electronically, paper claims are accepted if on the proper type of form. Health Net prefers that all claims be submitted electronically.
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