Attention Network Providers: 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, as communicated and reinforced in the Provider Manuals, regarding claims completeness and accuracy.
MEMBER NAME: Enter the client’s last name, first name, and middle initial exactly as printed on the Member’s Identification Card, State file, or Payor Eligibility File. Claims not matching the exact name format will be rejected.
SPECIAL BILLING: The billing guidelines listed below must be used for newborn claim submission:
- Always use “boy” or “girl” first and then the mother’s full name. An exact match must be submitted for the claim to be received and processed. (Example: If the Mother’s Name is “Jane Jones”, use “Boy Jane Jones” for a male child and “Girl Jane Jones” for a female child.)
- For twins/separate claims, enter “Boy Jane Jones” and “Girl Jane Jones” (boy/girl twins) or “Boy A Jane Jones” and “Boy B Jane Jones” (boy/boy twins), or “Girl A Jane Jones” and “Girl B Jane Jones” (girl/girl twins).
- 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.
For additional information, please refer to your Provider Manual:
Our Provider Relations staff is also happy to assist. Contact your Provider Representative directly, call (210) 358-6294, or email ProviderRelations@cfhp.com.