Date Issued: 12/16/2015
HIP and CompreHealth Benefit Plans
If you have submitted a paper claim for a HIP or CompreHealth HMO/EPO plan member that was denied because critical information was invalid or omitted and you would like to make changes to the claim for an additional review, please resubmit the claim with corrections directly on the original form (professional CMS-1500 or facility UB04) as you would an original claim request. If we have any questions regarding your claim request, we will contact you at the phone number you provide on the form.
GHI EPO/PPO Benefit Plans
For corrected GHI EPO/ PPO paper claims that require resubmission, the EPO/PPO Corrected Professional Paper Claim Form must be included. Corrected GHI EPO/PPO paper claims without this form will be treated as a new claim submission and denied as a duplicate.
Instructions for completing the form and submitting it with the corrected claim:
- Use a separate EPO/PPO Corrected Professional Paper Claim form for each corrected claim.
- Provide the original claim number. You can find this number on your Explanation of Benefits. You may also access it by signing in to our secure website at emblemhealth.com. Select "Claims/Checks" and complete the requested information to view the claim in question.
- Check the box that corresponds to the claim information you need to correct and make the correction.
- Attach the updated CMS-1500 claim form to the EPO/PPO Corrected Professional Paper Claim Form.
- Mail both forms to the PO Box that corresponds to your correction. If more than one piece of information must be corrected on the claim, send the form to the address for the most important information. Our Claims department will forward to the appropriate resource for processing.
Note: Corrections to a claim should only be submitted if the original claim information is incorrect or incomplete. Practitioners may not use a corrected claim in place of the formal grievance or appeal process.
For more information, please refer to our Claims Corner article on Avoiding Duplicate Claim Submissions.
