You’re still responsible for ensuring that your care is precertified. In most cases, your network provider will take care of getting precertification. How do I precertify for a hospital admission? If you are admitted for services or supplies we don’t cover – for example, non-covered cosmetic surgery – we will not pay any benefits. You must get precertification for certain types of care rendered by non-network providers to avoid a reduction in benefits paid for that care. So, it’s your responsibility to contact MHBP to precertify those services which require precertification. Note: This plan pays non-network benefits and you may self-refer for covered services. When you get services that require precertification through a participating provider, this provider should precertify those services prior to treatment. In some instances, precertification is used to inform physicians, members and other healthcare providers about cost-effective programs and alternative therapies and treatments.Ĭertain health care services, such as hospitalization or outpatient surgery, require precertification to ensure coverage for those services. It also allows MHBP to coordinate your transition from the inpatient setting to the next level of care (discharge planning), or to register you for specialized programs like Care Management Program or our prenatal program. The process permits advance eligibility verification, determination of coverage, and communication with the physician and/or you. Precertification is the process of collecting information prior to inpatient admissions and performance of selected ambulatory procedures and services. Precertification Questions What is precertification? View the appeals/disputed claims process. What should I do to file a disputed claim? Follow the Federal Employees Health Benefits program disputed claims process if you disagree with our decision on your claim or request for services, drugs, or supplies, including a request for preauthorization/prior approval. If you have questions, just call us at 1-80 (TTY: 711). Complete the form and mail it to the address on the form. When you use non-network providers you may have to file your own claim. Present your ID card at the time of service and your provider will file the claim for you. However, if you need to submit a claim please use the following address:īirmingham, AL 35238-5018 How do I file a claim? When you use a network provider, you don’t need to file a claim. Where do I send my claim? Network providers usually file claims for you. How do I obtain a claim form? For your convenience, you can view and download a copy here. Be sure to write your MHBP ID number on your itemized bill and include it with the claim form. If you use an out-of-network provider, you may have to submit a claim. It includes the address your provider will need to submit your claims. Make sure you carry your ID card with you. Just show your ID card, and your provider files the claim for you. of the official plan brochure under Coordinating Benefits with Medicare and Other Coverage.Ĭlaims Questions Do I need to submit a claim form? When you use a network provider, you don’t need to file a claim. įor complete details about how we coordinate with other health plans and a Primary Payor Chart, see Section 9. For more information on NAIC rules regarding the coordinating of benefits, visit. We, like other insurers, determine which coverage is primary according to the National Association of Insurance Commissioners’ (NAIC) guidelines. When you have double coverage, one plan normally pays its benefits in full as the primary payor and the other plan pays a reduced benefit as the secondary payor. Follow the list and Avoid Tfl denial.Plan Coverage Questions What should I do if I have other health coverage? You must tell us if you or a covered family member has coverage under any other health plan or has automobile insurance that pays health care expenses without regard to fault. One such important list is here, Below list is the common Tfl list updated 2022. There is a lot of insurance that follows different time frames for claim submission. One of the common and popular denials is passed the timely filing limit.
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