D5_IHSclaimsChecklist.pdf
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- Attached to
- Non-Personal Healthcare Services-Physicians & Other Professional Ambulatory Services for PRC Program
- Solicitation number
- 75H70726R00002
About this file
This document is an instructional flier from Blue Cross and Blue Shield of New Mexico outlining procedures for healthcare providers to submit claims to the Indian Health Service (IHS) Fiscal Intermediary (FI). The flier provides guidance to ensure timely, accurate, and delay-free claim processing.
Providers must submit three key components with each claim packet: a Purchase Delivery Order (PDO) with exact matching patient names, provider EINs, and billing addresses; a complete and legible claim form (CMS-1450, CMS-1500, or ADA) containing all required service dates, codes, and charges; and a final Explanation of Benefits (EOB) from every insurance carrier with matching patient names, service dates, and total charges. For paperless PDOs, providers must write the PDO number in specified boxes on the respective claim forms. All related charges must be submitted with the original PDO, and additional or late charges require a new PDO from the IHS Service Unit. Denial and remark code descriptions are mandatory on EOBs, and providers must submit supplemental information to carriers, the Service Unit, or the FI as needed. Claims must be mailed to P.O. Box 13509, Albuquerque, New Mexico 87192-3509; faxed claims are not accepted due to legibility concerns. First-time filers must include a completed W9 form with their submission.
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Blue Cross and Blue Shield of New Mexico www.bcbsnm.com/ihsfi/providers.html IHS/PRC FI Customer Service 1-800-225-0241 Rev. 8.28.2015
How to File IHS Claims In order to have your claims processed timely, accurately and without delays, please review the following tips with your staff and post this flier.
1) Include the following documents when submitting claims to the FI:
· Submit a Purchase Delivery Order (PDO) ü Patient’s name on the PDO must be an exact match to name on claim.
ü Provider’s EIN and billing address on PDO must be an exact match to claim.
ü If approved for paperless PDOs, write the PDO number on the claim as follows:
o Box 23 of a CMS-1500 form o Box 63 of a CMS-1450 form o Box 35 of an ADA form
· Submit a Claim Form (CMS-1450, CMS-1500, ADA) ü All claims must be complete and legible. Missing, invalid, or illegible dates of service, codes, charges, bill type, and other claim information may result in payment delays.
ü Submit all related charges with the original PDO. Additional/late charges require that you contact the IHS Service Unit for a new PDO.
· Submit a final (not interim denial), legible Explanation of Benefits from every insurance carrier (patient’s insurance is indicated on PDO) ü Total charges on the EOB must match total charges on the claim.
ü Patient’s name on the EOB must match patient’s name on the claim.
ü The date(s) of service on the EOB must match the date(s) of service on the claim.
ü The denial/remark code descriptions are required by the FI. If they are missing or illegible, payment may be delayed until this information is received.
ü Provider must submit additional information to the carrier, the Service Unit, and/or the FI as required for denials.
2) Mail the packet to the address at the top of this form. Do not fax claims – faxed copies are often illegible, which may cause delays in processing.
3) Submit a W9 form with the claim if you have never filed a claim with the FI.
File details come from the government source that posted it. Updated .