claim submission guideline form SHP

Claims Submission

Claims are to be submitted to Simply Healthcare Plans with appropriate documentation by mail or filed electronically for CMS-1500 and UB-04 claims. For those members that may be assigned to a delegated medical group/IPA that does its own claims processing, please verify the “Remit To” address on the SHP Member ID Card. Providers billing SHP directly should submit claims to:

Simply Healthcare Plans, Inc.
Attn: Claims
PO BOX 21535
Eagan, MN 55121

Providers are expected to use good faith effort when billing SHP for services by using the most current coding (ICD-9, CPH, HCPCS, etc.) available. The following information is to be included on all claims submissions, electronic or paper:

3. Member’s name, date of birth, sex and ID number

4. Date(s) of service, place of service(s) and number of days or units, if applicable

5. Provider tax identification and NPI number

6. ICD-9 diagnosis codes by specific service to the highest level of specificity

7. Current CPT, revenue and HCPCS procedure code(s) with modifiers is appropriate

8. Billed charges per service(s) provided and total charges

9. Provider name and address, signature, and phone number

10. Information about other insurance coverage, Workers’ Compensation, accident or auto information, if available

11. Attach a detail description of the service or procedure for claim submitted with unlisted medical or surgical CPT or other revenue codes

12. For resubmissions and corrections of a claim, please submit a new CMS 1500 or UB-40 indicating the correction.

Claims must be submitted on the proper claim form, either a CMS-1500 or UB-04 and must contain the information noted above. SHP will only process claims that are legible and filed on the appropriate claim form and containing the required data information. Claims filed that are incomplete, inaccurate, or untimely re-submissions may result in the denial of the claim.

Filing a Claim Electronically
Providers submitting claims electronically should receive an acknowledgement from WebMD
or their current clearinghouse; if you experience any problems with your transmission please
contact your local clearinghouse representative

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