Updated Corrected (Replacement)/Voided Claim Request Form
Neighborhood has updated its Corrected Claim form to include a field for the provider’s mailing address. Please be sure to use the most current version of the request form, as outdated forms will be returned to the sender for correction and resubmission.
Paper Claim Submission Reminder
Neighborhood uses technology to scan paper forms and eliminate keystroke errors. All new and replacement/voided paper claims must therefore 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.