HELPFUL REMINDERS TO ASSURE CORRECT ADJUDICATION OF YOUR CLAIMS:

• Claims submitted using the CMS 1500 claim form must have all information properly aligned within each CMS box for scanning purposes. 

• Date formats must be precisely followed for scanning purposes, (ex: mmddyy). 

• Both bBoxes 4 and 7 must be completed.  "Same" is not acceptable.

• Claims submitted on paper must be typed or computer generated.

• No punctuation should be used on the claim, including but not limited to: hyphens, apostrophes, dashes, periods (after St. Dr., D.C., etc...), commas, etc.
• Claims must be filed with the patient’s and insured’s complete name per the Insurance ID card.  Do not use abbreviations or nicknames.

 

Please note: If you use spaces within a patient's name, the computer systems that our payors use will mis-read the patient name. For example, if McAdams is sent as Mc Adams, the payor interprets the patient last name as "Mc" and patient first name as "Adams." Please make sure to exclude all spaces in a patient's and insured's name.

• Whether the claim is filed electronically or by paper, the claim must be identified by the HNS contract name in the address section at the top of the CMS 1500 clam form. (HNS/BCBS is an acceptable format.)  Be sure you put the HNS address here, not the address listed on the insurance ID card.

• The complete member ID number must appear in box 1a, exactly as it appears on the member ID card, including alpha prefix and SUFFIX, if applicable.

• The patient's and insured's correct date of birth must be on all claims.

• Always make sure the “relationship to insured” in box 6 on the CMS 1500 claim form is correctly marked with either self, spouse or child. "OTHER" should never be marked as the payors will not accept this on a claim form.

• If unsure about what to put in box 11, 11b, and/or 11c of the CMS 1500 claim form, complete your HNS Fax Inquiry Form and fax a clear, legible copy of the front and back of the patient’s ID card to HNS.  We will gladly fax you the correct information.

• Box 11c must contain the plan name such as BCBS, CIGNA, Guardian/MedCost. If your practice management software limits the number of characters allowed in this field, please use your HNS Fax Inquiry Form to fax a clear, legible copy of the Member ID card to your HNS Provider Rep and we will assist you in abbreviating the payor name.

• Dates of service for different calendar years must be submitted on separate CMS 1500 claim forms.

• Total charges must always be in boxes 28 and 30.

• No more than 6 services may be listed on any CMS 1500 claim form.  

• Boxes 11, 11b and 11c must be completed and box 11c must contain the plan name, such as BCBS, CIGNA, etc... You may also put BCBS/HNS, however, HNS and Major Medical are not plan names and are not acceptable.

• When filing a primary diagnosis code between 800.00 and 999.00, or if the claim is accident related, the correct date of onset must appear in box 14 of the claim form.

• Be sure that your diagnosis pointers in box 24e do not exceed the number of diagnoses represented in box 21. For example, if a service was performed that applied to all four diagnoses in box 21, box 24e should state "1-4" not "1-6."
• The correct number of units must be included for each code submitted. HNS will assign a unit of one (1) to any service line(s) on the claim that does not not show the number of units.

• The provider's Type I NPI number must be in box 24J on each service line.

• The provider's Type II NPI number must be in boxes 32a & 33a. If you do not have a Type II NPI number, then you should use your Type I NPI number in these boxes.

• The most current ICD-9 and CPT-4 coding must be used.

• All equipment and supplies must be filed using the correct HCPCS code. Some DME services may not be covered so please always check with your HNS Provider Rep for clarification.

• Make certain the provider’s correct, legal name appears in box 31. The name should be computer generated or typed so that it is clearly legible.  (“Signature on file” is not acceptable!)

• Box 32 must contain the provider’s physical address.

• Claims must be submitted within 10 days of date of service.

NOTE: BCBSNC reserves the right to deny payment if a claim is submitted 180 days after the date of service.  As a participating provider with BCBSNC, you may not bill the member for claims submitted after 180 days.

• If submitting a corrected claim, always staple the appropriate EOB directly to the CMS 1500 claim form and submit to HNS.

• If attaching a primary EOB or NOP, always staple it to your CMS 1500 claim form.

• HNS providers are required to file secondary coverage for all HNS contracts.  ALL SUCH CLAIMS MUST BE SENT DIRECTLY TO HNS. 

• When filing claims for members with secondary coverage, always complete box 11d as well as boxes 9a-d of the CMS 1500 claim form.  These boxes must be completed on each CMS 1500 claim form when filing BOTH the primary and secondary carriers.  When filing for secondary coverage, you must first attach (staple) a copy of the EOB from the primary carrier to the CMS 1500 claim form and send directly to HNS.

• If you are a North Carolina provider filing BCBS as secondary coverage to Medicare, you must generate a new CMS 1500 claim form, complete boxes 11d and 9a-d, staple a copy of the primary EOB to the claim and submit to HNS.  Medicare crossover to BCBSNC will not result in payment by the secondary carrier for BCBSNC HNS contracts.  Claims with BCBSNC as secondary must be sent directly to HNS.

• If HNS sends you a HNS Electronic Claim Error Report, please make the appropriate correction in your computer software program and resubmit the claim through HNSConnect.

• If HNS returns a claim to you for correction with a HNS Claims Return Form, please make the correction and staple this form to your corrected CMS 1500 claim form and return BOTH to HNS. Do not mark the claim Corrected as HNS will know it is corrected by the return of the HNS Claims Return Form.

• Resubmit ALL corrected/lost/missing claims through HNS.

• If you receive a request for additional information on a specific patient from the insurance company or payor, you should return the requested information immediately.  Always return the information to the entity that requested it, not to HNS.  (These claims are placed “on hold” by the payor and will not be processed until the information has been received.)

• Refer to your HNS Fee Schedules to confirm allowable amounts and CPT codes.  (All current HNS Fee Schedules can be found on the secure portion of this web site and you will be notified if there are any updates to our fee schedules.)