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Administrative Manual

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Filing Claims

Learn about information and tools you need for submitting claims and receiving payment:

Learn more about

Description of information

Appeals

Learn how to appeal the processing of a claim due to a billing/coding edit dispute, or a medical necessity or investigational service denial.

Benefit Coordination

Learn about coordination of benefits, overpayment recovery and other party liability.
Coding Toolkit Find out how our claim system uses customized editing rules and Medicare’s National Correct Coding Initiative (NCCI) to create clinical edits and how this impacts your reimbursement.
Dental Billing Learn about dental claims submission requirements and predeterminations.

Electronic Transactions

Learn how to submit claims electronically and become familiar with other valuable electronic transactions such as eligibility and benefits, claim status and pre-authorization inquiries.  

ICD-10 Learn about ICD-10 timeframes, requirements and available resources.

Message Codes

View voucher message codes.

Modifiers

Learn about our modifier reimbursement policies and how they impact your reimbursement.

Other Billing Information Locate billing information not found elsewhere.

Provider Center

Use this online tool to view the status of submitted claims, claim vouchers, member benefits and eligibility and more.

Submitting Claims

Learn about UB-04, CMS 1500 and ADA J-400 claims submission requirements including corrected claims, timely claims filing and submitting supporting documentation.

Revised March 2012

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