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.
- To make a change to a previously-submitted claim, remit a Corrected Claim Submission Request Form, with a “7” or “8” indicated in Field 4 on a UB-04 form or Field 22 on a CMS-1500 form, along with the claim.
- It is important to reference the correct original claim number (from the initial submission of the claim being replaced) when resubmitting a corrected claim.
- Submit all relevant claim lines for the encounter, not just the lines requiring a correction.
- Be sure to print or type all information on the claim form. Handwriting is not accepted, and will cause the claim to be returned to the sender.
Adjustment Request Form
Neighborhood’s Adjustment Request form is now available online in a secure electronic format. Although a fillable PDF version is also offered, use of the electronic version saves time and postage!
Updated Reconsideration Request Form
Neighborhood has updated its Reconsideration Request form to clarify requested information that is required, not optional. In addition, the Provider Services phone number has changed to one that is toll-free. Please be sure to use the most current version of the request form, as outdated forms will be returned to the sender for correction and resubmission.
Please remember to use the most current request forms available on our website. Provider request forms are available in the Claim Forms section of the Provider Manual Forms 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 Outdated forms will be returned to the sender for correction.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 Claim Forms section of the Provider Manual Forms 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 for.