Claims Corner

January 2022

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.

Claim Reconsiderations – New eForm Submission Option!

Reconsideration requests may be submitted online through a new, web-based electronic form (eForm).  The Claim Reconsideration Request eForm gives providers a more efficient way to request reconsideration on a previously adjudicated claim(s).

Multiple requests for claim reconsiderations may be submitted, but each request must include a completed Claim Reconsideration Request Form or eForm, 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.

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.

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.

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.  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.

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.

Requests for multiple claim adjustments, up to fifty (50) at a time, may 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.