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CMS 1500: Required Information
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Box
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Member ID# (including 2-digit suffix)
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1a
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Patient's name
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2
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Other insurance (for internal routing purposes only)
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9 & 10
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Referring physician's name
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17
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Referring physician's provider ID#
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17a
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Diagnosis code(s) (accurate to the 4th or 5th digit)
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21
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Dates of service
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24a
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Place of service (location code)
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24b
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CPT/HCPCS code
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24d
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Charges
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24f
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Federal tax ID#
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25
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Provider name, full address, and ConnectiCare provider ID number (6 or 10
digits; a.k.a. pin number), and site number (if applicable)
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33
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UB04: Required Information
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Box
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Facility name and full address
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1
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Type of bill
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4
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Federal tax ID#
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5
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Statement covers period
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6
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Patient's name
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12
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Revenue code
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42
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CPT or HCPCS/Rates (if applicable)
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44
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Total charges
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47
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Indication of dual payers (so that claims are appropriately routed through
the Coordination of Benefits workflow)
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50
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ConnectiCare provider ID number (6 or 10 digits)
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51
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|
Member ID#
|
60
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|
Principle diagnosis code
|
67
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|
ICD-9 Procedure Code
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80/81
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In addition to the required elements on the claim form, there are
additional items of information that may be needed so that the claim may be
processed, such as verification of student status, or third-party liability. NPI
is also preferred (line 17b) to expedite
processing.
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Paper claims should not be submitted by FAX. If we receive a FAX
that is not readable, we will need to request that the provider resubmit a hard
copy, adding to the processing time for the claim.
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Submit claims to: |
ConnectiCare
P.O. Box 546
Farmington, CT 06034-0546
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CLAIM EDITS
ConnectiCare evaluates medical billing information and coding for
accuracy and appropriateness. This practice is designed to detect coding
patterns such as unbundling, integral procedures, and mutually exclusive
procedures.
In addition, ConnectiCare’s claims payment system will adjudicate claims based on CMS (Centers for Medicare
& Medicaid Services) and NCCI (National Correct Coding Initiative) edits.
ConnectiCare considers coding edits that are based on industry sources,
including but not limited to CPT guidelines from the American Medical
Association, specialty organizations, and CMS. In coding scenarios where there
are conflicts between sources, ConnectiCare will apply edits that ConnectiCare
determines are most appropriate.
For questions about why a particular claim was denied based on a
coding edit, refer to your Explanation of Payment (EOP), the summary of Common
Billing Scenarios*, found in, Billing &
Claims Payment Policy. Or, contact Provider Services at (860) 674-5850 or 1-800-828-3407
* ConnectiCare will update coding information in the Common
Billing Scenarios section upon reprint of subsequent editions of the Physician
& Provider Manual. More up-to-date information may be available on our
website at www.connecticare.com.
CLAIM PAYMENT
ConnectiCare processes claims daily and issues remittance checks
weekly. Generally the Explanations of Payment (EOPs) and checks are mailed first
class within 48 hours following the day on which they are produced. However,
providers who receive payment via EFT may not receive a paper EOP statement, but
have access to their EOP online via, Provider Connections, ConnectiCare's online
tool for providers. ConnectiCare
cannot pull a check or an EOP for a provider to pick up.
To receive your funds sooner, we strongly encourage the use of
Electronic Funds Transfer (EFT). See Electronic Funds
Transfer for more information.
FRAUDULENT STATEMENTS & CLAIMS
Any person who knowingly and with intent to defraud any insurance
company or other person files a statement or claim containing any false
information, or conceals, for the purpose of misleading, information concerning
any fact material thereto, commits a fraudulent insurance act, which is a crime
punishable under applicable laws.
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