The Life of a Claim

1. The Life of a Claim Service Center

3. Claims Submission • Payment for Clean Claims • Claims Denials • Review and Determination Agenda

4. Claims Submission • Claims may be submitted by one of the following methods: • Electronically • Provider Direct • Claim form instructions can be found at the below links: • UB04 – For submission of Institutional claims, hospital, residential and ICF http://www.nubc.org/ • CMS1500 – For submission of outpatient physician claims http://nucc.org/

5. Payment for Clean Claims • Claims are paid by electronic funds. The EFT application can be found at the following link: http://www.cardinalinnovations.org/providers/getting-paid/finance/forms-information • Claims must be submitted by 5:00pm on the cut-off date in order to receive payment the following week. • Payments are processed based on the check-write schedule found at the following link: http://www.cardinalinnovations.org/providers/getting-paid/finance/billing-information • Claims must be submitted by 5:00pm on the cut-off date in order to receive payment the following week.

6. Claims Denials • Where can I find claims denial information? • Refer to the FAQ link below where you will find answers to common questions and a detailed explanation of denial codes. http:// www.cardinalinnovations.org/providers/getting-paid/finance/billing-information • How do I refile? • Resubmission guidelines can be found at the below link: http://www.cardinalinovations.org/providers/getting-paid/finance/billing-information • What are the time limitations? • Claims should be submitted within 90 days from DOS. Hospitals and claims involving COB should be submitted within 180 days from DOS.

7. Review and Determination • Process for requesting review for an authorization issue within 60 days from DOS or claim denial within 120 days from DOS • Additional information can be found at the following links: • http://www.cardinalinnovations.org/providers/network-providers/review-determination-process • May 16, 2014 Infosource Newsletter http://www.cardinalinnovations.org/providers/resources/infosource

8. CLAIMS SUPERVISORS Annette James – Group A Claims (Specialty) 704-939-7734; annette.james@cardinalinnovations.org Beth Parker Thompson – Group B Claims 704-939-7743; beth.thompson@cardinalinnovations.org Dolores Cuccaro – Hospital/Physician/Institutional 704-939-7729; dolores.cuccaro@cardinalinnovations.org Contact Information