Claims Corner

December 2019

Claims Processing Update – Facility Claims

A claims processing issue was identified that may have resulted in incorrectly processing secondary payments on institutional claims for our Commercial and INTEGRITY lines of business. Effective 1/01/2020, all secondary claims payment inconsistencies should be resolved. If you have questions about your claims payment, please call Provider Services at 1-800-963-1001.

Certified Mail

When calling to obtain the status of documents sent to Neighborhood via certified mail, submitters must provide the mail tracking number from the bar code on the package.  Use of this number makes it faster and easier to track Neighborhood deliveries.

Check Submission for Overpayments

Please do not send unsolicited checks to Neighborhood for overpaid claims.  The best practice is to submit a completed Adjustment Request Form, without a check, and detailing the reason for the overpayment.

Current Forms

Please remember to use the most current request forms available on our website.  Provider request forms are available in the Forms section of the Provider Resources menu on the Neighborhood website.  The Corrected Claim, Reconsideration, and Appeal request forms are writeable, so they can be typed online, then printed and submitted to Neighborhood.  Outdated forms will be returned to the sender for correction.

For help deciding which form to use, the Claim Form Finder, located in the Forms section of the Provider Resources menu on the Neighborhood website can help to determine which form must be completed and submitted to Neighborhood, along with additional information related to the submission of each form.

Claim Submission Reminders for Providers and Billers

  1. Neighborhood uses technology to scan paper forms and eliminate keystroke errors. All new and corrected claims must be submitted on original (not photocopied) print versions of the industry standard CMS-1500 and CMS-1450 (UB-04) forms, as they are printed in special optical character recognition (OCR)-scannable red ink.
  2. Claim forms must not contain any handwritten elements, stamps, correction fluid, or staples.
  3. Data entered on the claim form must be properly aligned and fall completely within the applicable text fields. Data that is misaligned or ghosted elsewhere on the form is systematically recognized as an error and will result in the claim being returned to the sender for correction.
  4. It is not necessary to provide a W-9 form with a claim unless it is the first time a claim is submitted to Neighborhood on a provider’s behalf.