Helpful tips to avoid claims delays

Regence is continually looking for ways to ensure your claims are processed quickly and efficiently. These tips generally apply to claims submitted using a CMS-1500 claim form. However, some of the tips are valuable reminders for all paper and electronic claims.

1. Make sure data completely fits into the data field. Any data outside its field makes the original data unreadable or pushes adjacent data out of place. If the data doesn't fit, realign it or reduce the font size. Data must remain within the confines of its field.
   
   
2. Type or neatly print the provider's signature or name in field 31. Unreadable names or signatures will cause delays in claims processing.
   
   
3. Do not add "signature on file" in field 31. This results in the claim being transmitted with an invalid provider name. If an individual provider rendered the services, type or neatly print that provider's name in field 31.
   
   
4. Do not enter a date in field 31 if you leave the signature field blank. Even a date entered in this field can cause our automated processing system to view the data as a signature and try to match it, resulting in the claim pending for investigation. Therefore, if you are not entering a provider's name in field 31, please do not enter a date.
   
   
5. Do not shorten your identification (ID) number. Your Regence provider ID number (Regence ID) may contain from nine to 14 digits, depending on the state in which you practice. If your Regence ID is 23456789010001, make sure you enter the complete number, including all zeros. This also applies to your National Provider Identifier (NPI) number. Always enter the correct and complete numbers for proper claims processing.
   
   
6. All information on the claim should be typed or neatly printed. We use an electronic scanning system for faster claims processing. Typed claims are preferred because illegible handwritten information can result in delayed claims payments.
   
   
7. Always use the provider's full name in the return address block of mailing envelopes. When our off-site data processors receive paper claims in an envelope, they often assign the name listed in the return address block of the envelope to all claims contained within. If your name in our files is Alpha Beta Clinic, using the acronym ABC on your return address may result in all claims in the envelope being assigned to the wrong provider or pended for investigation.
   
   
8. Submit Coordination of Benefits (COB) information electronically. If you typically file claims electronically when Regence is the primary payer, you may also file electronically if we are the secondary payer. Use the American National Standards Institute (ANSI) X12 loop, 2330B (other pay information) to identify who the primary payer is; use ANSI X12 loop, 2430 (line adjustment information) to identify the amounts paid.
   
   
9. Always include the complete member number, including alpha prefix. The member's plan information is identified by the unique three-character alpha prefix. Always include the complete member number, including alpha prefix, exactly as it appears on the member card.
   


10. Verify your provider information is correct in our files. Frequently review your information listed in our provider directories to ensure it is accurate. Incorrect addresses or ZIP codes can delay claims processing. Submit any corrections via our Provider Information Update Form or contact your provider consultant.
    
    
    
    As a reminder, do not submit changes of address on the claim form with the assumption that we will update our files with the new information. An unfamiliar address will result in your claim being pended for investigation. This will delay payment and the address update process will take longer than if it were submitted online or through your provider consultant.
    
    
11. Report tax ID changes or updates. The tax ID submitted on claims must match the tax ID we have on file. Promptly report any changes using our Provider Information Update Form or contact your provider consultant.
    
    
12. Submit patient and subscriber information on every claim. Neglecting to specify this information may result in the claim being processed for the wrong patient.
    
    
13. Submit the correct Regence ID and NPI (if available) in field 24J on the CMS-1500 (08-05) claim form. If the rendering provider is different from the billing provider, the rendering provider's Regence ID must be entered in field 24J. While an NPI is not required for paper claim submissions, if the rendering provider has an NPI, it may be entered on the line below the Regence ID. A mistyped Regence ID or NPI number will result in the claim pending for investigation, or the payment may be assigned to the incorrect provider.
    
    
14. Always submit the billing provider's name, address, phone number and NPI (if available) in field 33 on the CMS-1500 (08-05) claim form. Failure to include complete information will result in the claim pending for investigation, or the payment may be assigned to the incorrect provider.
    
    
15. List the service facility address in field 32. Always list the correct address where services were rendered. If the NPI associated with this address is different from the billing provider's, list the billing provider's NPI as well.
    
    
16. Use of CMS-1500 versions other than the (08-05) version. If you are using an older CMS 1500 claim form version, do not submit with an NPI, as there are no fields available for this data.
    
    
17. Use valid codes. Be sure to use valid Current Procedural Terminology (CPT), Health Care Procedure Coding System (HCPCS) and International Classification of Diseases, Ninth Revision (ICD-9) codes along with the most current modifier, if applicable. In addition, code to the highest level of specificity possible.
    
    
18. Submit the same tax ID for the rendering provider as for the billing provider. Entering different tax ID numbers will result in payment delays or possible rejection for clarification.
    
    
19. Submit the provider's degree or title separately. When filing claims electronically, submit the provider's degree or title in field NM107 of the ANSI 837 claim form. Adding the degree or title to the provider's name causes the claim to be pended for investigation.
    
    
20. Submit claims electronically. The easiest way to ensure claims are entered correctly is to submit your claims electronically. Electronic billing significantly reduces errors and alerts you immediately if a key element is missing or incorrect. Learn more about electronic billing today.

 

Your cooperation in eliminating the most frequent errors helps expedite payment to you.

 

Return to newsletter index »

Back to Top