FAQs - Submitting Claims
Q: Why did I receive a Remittance Advice (RA) or check
with an individual doctor's name on the RA or check when the
individual doctor is only one member of our group?
A: When a group member is enrolled with his or her first
group, the group member is assigned a rendering provider number
with an "A" service location containing the group's addresses and
information. Therefore, if the billing group bills with the group
member number in field 33 (claims should never be submitted this
way) on the HCFA-1500 claim form, the claims are processed under
the group member's name and number. The Remittance Advice has the
group member's name and number on the check and Remittance Advice.
You must bill with the group number in field 33 and provide the
rendering provider's number in field 24J.
Q: Can a group provider use individual provider numbers
for billing to easily track who performs the service?
A: You must bill under the group number for payment (field
33), and you can track who rendered the service in field 24J on the
HCFA-1500 claim form. This information is provided on the
Remittance Advice.
Q: Why are changes not made to Provider Enrollment files
on a timely basis?
A: In many cases, the Provider Enrollment Unit does not
receive an enrollment update because the update was sent to the
wrong address, or because the fax did not complete. Please do not
send updates and enrollments via fax unless directed to do so by
HP. The Provider Enrollment Unit receives many incomplete faxes and
does not receive some faxes at all due to line signal mishaps and
fax memory capability. Also, please do not send address or provider
updates to the claims address - send updates to the Provider
Enrollment Unit as soon as they are known. Send provider enrollment
updates to the following address:
HP
P.O. Box 7263
Indianapolis, IN 46207-7263
Attention: Provider Enrollment
In addition, Provider Enrollment receives some updates that
cannot be processed as requested. The following are some of the
most common reasons that updates are not processed as
requested.
- HP does not process updates that are not on company letterhead
with an authorized officer's signature.
- HP does not process address updates for a group member's "A"
service location unless the group that originally enrolled the
group member has moved. This location information is linked to the
group that originally enrolled the group member.
- HP does not update a group member's number with a Clinical
Laboratory Improvement Amendments (CLIA) number.
- HP does not update a group member's number with a Medicare
billing number. The Medicare billing number associates with the
IHCP group number, and the Medicare rendering provider number
associates with the specific IHCP rendering provider. All Medicare
rendering provider numbers end in one or more alpha
characters.
Q: Why are my claims paying to the rendering provider
when I placed both the group's number and the group member's number
in field 33 of the HCFA-1500 claim form?
A: HP processes thousands of claims each day and keys the
first provider number found in field 33 of the claim form. Only the
group's provider number should be placed in field 33.
Q: Why are my claims being paid to a location where I
have not practiced for six months?
A: To have activity on a service location, someone had to
bill a claim for that service location. However, HP often receives
claims with service locations that are missing or wrong. It is
possible with paper claims for a keying error to take place. If
this is the case, an adjustment can be made to correct the issue.
Please verify the service location on each claim before submitting
the claim.