Claims Corner

October 2021

Coordination of Benefits

If a member notifies a provider that their primary insurance coverage (primary to Neighborhood) has terminated, it is the provider’s responsibility to notify Neighborhood’s Provider Services department. This will alleviate claims denying unnecessarily for another plan’s payment information and allow for subsequent claims to process appropriately.

Electronic Claim Reconsiderations

Multiple requests for claim reconsiderations may be submitted in one e-mail, but each claim must include a completed Claim Reconsideration Request Form, the applicable remittance advice, medical notes, and must be saved in a separate file.  Multiple claims combined into a single file will be returned to the provider for correction.

In addition, duplicate and triplicate reconsideration requests will not be responded to as neighborhood will use the first submission as the official request in these instances.  For additional information, please review the claim reconsideration process in the Provider Manual.

Electronic Claim Adjustments

A request to adjust a single claim may be submitted electronically via the web-based electronic form in the Forms section of the Provider Resources menu on the Neighborhood website.

Effective September 1, 2021, requests for multiple claim adjustments, up to fifty (50) at a time, may now be submitted electronically through the new web-based electronic grid.  Now, instead of downloading, saving, and e-mailing a grid, it can all be done online through the Neighborhood website in one easy step.  Submitters will receive confirmation of receipt and an issue number prior to resolution of the claims on the grid.

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  Outdated forms will be returned to the sender for correction.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.