A reminder to all Network Providers, as communicated and reinforced in the Provider Manuals, Community First Health Plans continues to receive claims that fail to meet the mandatory requirements of a “clean” claim. Please review the important information below regarding claims completeness and accuracy.

Enter the client’s last name, first name, and middle initial as printed on the Member’s Identification Card, State file or Payor Eligibility File. Claims not matching the exact name format, date of birth, and member/subscriber number will be rejected.

Special Billing:

The billing guidelines listed below must be used for newborn claim submission:

  • If the Mother’s Name is “Jane Jones”, use “Boy Jane Jones” for a male child and “Girl Jane Jones” for a female child.
  • Enter “Boy Jane Jones” and “Girl Jane Jones” or “Boy A Jane Jones” and “Boy B Jane Jones” (for twins/separate claims) or “Girl A Jane Jones” and “Girl B Jane Jones” (for twins/separate claims)
  • Always use “boy” or “girl” first and then the mother’s full name for newborn claim submission. An exact match must be submitted for the claim to be received and processed
  • DO NOT use “NMB” or “NBF”. This will invalidate your claim submission and it will be rejected.

*Claims that do not meet the above requirements will be rejected and returned to the Provider.

Provider Manual: CHIP, pages 212 and 213; STAR, Sections 6.5.5 and 6.6.3

For additional information, please contact Provider Relations at (210) 358-6294 or ProviderRelations@CFHP.com.

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