Claim Payment Procedures

It is the goal of HealthSpring's Claims Department to provide the most efficient and accurate processing and payment of claims. In order to speed processing, we require that all claims be submitted on industry standard HCFA 1500/UB92 forms, either by mail or electronically (EDI). If interested in submitting claims electronically, you may contact HealthSpring's Provider Relations Department at phone# (615) 291-7035 or toll-free at phone# (800) 230-6138.

REFER TO THE BACK OF THE MEMBER’S ID CARD FOR THE CORRECT CLAIMS’ MAILING ADDRESS.

As a HealthSpring participating Provider, you have agreed to submit all claims within 120 days of the date of service.  CLAIMS SUBMITTED WITH DATES OF SERVICE BEYOND 120 DAYS ARE NOT REIMBURSABLE BY HEALTHSPRING. Print screens are no longer accepted to validate timely filing.  A Participating Physician shall not request or collect any professional fees over the office visit co-payment amount until payment information is received from HealthSpring.

Checking Claims Status

To check the status of a claim, prior to 60 days post-date of service, visit HSConnect.  The Provider Relations Department will not be able to verify claim status via the telephone until 60 days post date of service.

Timely Filing for a Corrected Claim

Providers, you have 180 days from the date on the Remittance Advice to submit corrected claims to HealthSpring. Please make note of this in order to submit your corrected claims within this time frame for processing.

Claims Submission and Optical Character Recognition (OCR)

HealthSpring uses Optical Character Recognition (OCR) scanning of paper claims. OCR technology is used to “read” the paper claims so they can be input in our claims payment system as they arrived electronically (EDI). We have included below a few requests and reminders for our providers about paper claims submission formatting. Compliance with these requests and adherence to the published Claim Completion Instructions from Medicare will greatly increase the accuracy of our OCR engine’s “read” of the claims. Every increase in accuracy and efficiency decreases the turnaround time on your claim payments.

The entire required Claim Completion Instructions can be found: www.cignamedicare.com/dmerc/dmsm/C06/sm0603.html

Rules for Preparing a HCFA 1500 for OCR Processing:

  1. Use the Standard Red Form. Our Scanner uses red lamps to dropout the background on a HCFA 1500. When black background HCFA’s are used, the form lines and titles interfere with the data we are extracting.
  2. Make sure your printer/typewriter is properly aligned. When items on the HCFA are printed in the incorrect location or out of alignment with the form definitions, data may be associated with the wrong field. To avoid this, please check your printed forms and make adjustments to your printer alignment when necessary.
  3. Make sure toner is well stocked and functioning properly. When forms are printed too tightly they become extremely difficult, if not impossible, to process. Please be sure your printer is clearly and cleanly printing data on the HCFA 1500.
  4. Refrain from Italic fonts. Using Italic fonts on the HCFA 1500 will decrease the accuracy rates of the OCR engine and therefore lead to slower processing of the forms.
  5. Avoid Unnecessary Descriptions as described in Medicare claim completion instructions. In the Diagnostic Code Section (Section 21) please refrain from printing descriptions of the codes included. The code itself is read by the OCR software and additional text in the area will result in poor results. Narrative diagnosis should be sent as an attachment with the ICD-9 code in section 21. In section 24D, enter the codes only. Required narrative descriptions should be entered in section 19 (reserved for local use) or sent as an attachment.
  6. Print UPIN in designated spot as required by Medicare claim completion instructions. The UPIN is a requirement for claim completion. When it is not present on the claim or in the wrong locations, it dramatically slows the processing of the claim. UPIN should be entered in 24K if provider is a member of a group practice. UPIN should be entered beside PIN # in 33 if provider is in individual practice.

TriCare for Life (formerly CHAMPUS) – Armed Forces Retiree Program

•          Medicare is always PRIMARY.

•          For more information call 1(888) 363-5433.

•          HealthSpring will file EOB’s directly to TriCare on behalf of the member.