These claims will not be returned to the provider. Paper claim forms must be typed in black ink in either 10 or 12 point Times New Roman font, and on the required original red and white version of the form, to ensure clean acceptance and processing.Ĭlaims submitted on black and white, handwritten or nonstandard forms will be rejected and a letter will be sent to the provider indicating the reason for rejection. When billing CMS-1500, California Health and Wellness only accepts standard claim forms printed in Flint OCR Red, J6983 (or exact match) ink. If non-compliant, paper claims follow the same editing logic as electronic claims and will be rejected with a letter sent to the provider indicating the reason for rejection.
#Timely filing denial code manual
The form must be completed in accordance with the guidelines in the National Uniform Claim Committee (NUCC) 1500 Claim Form Reference Instruction Manual Version 5.0 7/17. Providers billing for professional services, and medical suppliers, must complete the CMS-1500 (version 02/12) form. Requirements for paper forms are described below. Refer to electronic claims submission for more information.įor providers unable to send claims electronically, paper claims are accepted if on the proper type of form.
California Health and Wellness requires that Enhanced Care Management/Community Service (ECM/CS) providers submit fee-for-service professional claims on the paper CMS-1500 claim form, EDI 837 professional, or California Health and Wellness invoice form.Ĭalifornia Health and Wellness prefers that all claims be submitted electronically.
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