Claims Edit Update

In order to gather more accurate data for quality improvement projects and operational analyses, Neighborhood Health Plan of Rhode Island (Neighborhood) will implement the following edit on all claims (paper and electronic) submitted for payment:

Box 32, CMS 1500 Form, “Name/Address of Facility Where Services Rendered”, must be completed.  Effective August 15, 2005 claims will be denied if Box 32 on your CMS 1500 form is not completed to reflect the address where services are rendered.  Please be sure to capture this information on your electronic claims submission as well.

For more information regarding required fields on the CMS 1500 Form, please refer to Pages 24-25 of the Provider Manual, which is available online.