Claims Corner

April 2022

Claim Adjustments

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

Requests for multiple claim adjustments, up to fifty (50) at a time, must be submitted electronically through the 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.

Reminder: Do not attach claims or medical notes to adjustment requests.  Such requests will be returned to the sender for correction and resubmission.

Claim Reconsiderations

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

Reconsideration requests may now be submitted online through the Neighborhood website.  Populate the required information on the eForm, upload the applicable Remittance Advice and medical notes, and receive immediate notification of a successful submission.  Neighborhood will require exclusive use of the eForm beginning June 1, 2022.

Please note that Neighborhood will not respond to duplicate and triplicate reconsideration requests, as the first submission will be considered the official request in these instances.  For additional information, please review the claim reconsideration process in the Provider Manual.

Claim Submission Reminders for Providers and Billers

  1. 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.
  2. Claim forms must not contain any handwritten elements, stamps, correction fluid, or staples.
  3. 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.
  4. 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.
  5. Populate fields 33 (Billing Provider) and 32 (Service Facility Location) on CMS-1500 claim forms carefully. If the service location is not receiving payment as intended, please contact Neighborhood Provider Services at (800) 963-1001 to make an update.

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.


Last updated: April 8, 2022 @ 9:35 am