Claims Policy and EDI Documents

Health Plus has implemented nationally recognized enhancements to our claims payment policies. We will continue to follow the guidelines set forth by the national Correct Coding Initiative (CCI). Our claims payment policy enhancements are based on nationally accepted guidelines, such as Medicare’s national bundling edits (including the CCI), Medicare’s modifier usage, Medicare’s global surgery rules, AMA CPT coding guidelines, regional Medicare policies, and national specialty academy guidelines (coding and clinical). More information regarding these enhancements can be found in the Frequently Asked Questions (FAQ) document below.

• Hospital Readmission Payment Policy - ( PDF, 49KB)
• PCP Bill Above List - ( PDF, 174KB)
• Claims Payment Policy FAQs - ( PDF, 55KB)
• 837P_Companion doc_NPI_Insert_V3 - ( PDF, 38.9 KB)
• 837I_Companion doc_NPI_Insert_V3 - ( PDF, 38.2 KB )
• Fraud and Abuse - ( PDF, 27.9KB)
• Appeals - ( PDF, 32.5KB)
• PAS and PAC Outpatient Hospital Services - ( PDF, 30.7KB)
• Implants - ( PDF, 28.6KB)
• PET Scans - ( PDF, 33.0KB)
• Transplants - ( PDF, 30.3KB)
• Pathology and Lab Services - ( PDF, 30.2KB)
• Radiology Services - ( PDF, 22.2KB)
• Consultations - ( PDF, 35.5KB)
• Anesthesia Services - ( PDF, 28.7KB)
• PCP Scope of Services - ( PDF, 29.0KB)
• FHP Co-payments - ( PDF, 31.2KB)
• UB 92 Outpatient Clinic Services - ( PDF, 28.4KB)
• UB 92 Claims Submission Requirements - ( PDF, 64.6KB)
• HCFA 1500 Claims Submission Requirements - ( PDF, 46.5KB)
• Electronic Claims Submission - ( PDF, 28.8KB)
• Timely Claims Filing - ( PDF, 29.9KB)
• EDI Institutional Companion Guide (837I) - ( PDF, 824KB)
• EDI Provider Companion Guide (837P) - ( PDF, 736KB)