Claim Submission Reminders for Providers and Billers
- 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.
- Claim forms must not contain any handwritten elements, stamps, correction fluid, or staples.
- 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.
- 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.
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 saved to your computer, 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 Outdated forms will be returned to the sender for correction.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.
Each claim reconsideration request submitted to Neighborhood by fax or secure e-mail must be sent as an individual reconsideration.
- A completed Reconsideration Request Form, remittance advice, and medical notes must be submitted as an individual request for each claim, even if requesting a review of multiple claims for the same member. Multiple requests saved to one file or attached to a single Reconsideration Request Form will be returned to the sender for correction and resubmission.