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Administrative Updates for Providers, Fall 2019

Sep 04, 2019
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Detailed information on claims submission pathways and requirements, replacement claims, claims reconsiderations, and new addresses for submitting appeals and reconsiderations.

(Policies and forms described in this section are online: https://healthoptions.org/providers/resources)

Reminder: Claims submission pathways and requirements

Electronic submission of claims is preferred and will provide the fastest and most accurate claims processing experience. Our Payer ID is 45341. We also accept paper claim submissions in accordance with our Paper Claims Submission Standards policy, found on our website (using the link above) in the Policies and Procedures section.

Replacement (a.k.a. corrected) claims

Health Options accepts replacement electronic and paper claims. Requirements are detailed in our Replacement Claim Billing policy, found on our website (using the link above) in the Policies and Procedures section. The correct original claim number (16 digits) must be included on replacement claims for accurate processing to occur. Please be mindful of the timeliness requirements for both original and replacement claim submission (120 days from date of service).

Claim reconsiderations

Providers can request reconsideration of a payment decision on previously processed claims while still retaining the right to file a future appeal, either by contacting our Member Service Department at 855-624-6463 or by completing and returning the most recent version of the Health Options Claim Reconsideration Form.  Reconsideration requests are considered timely when received within 90 calendar days from the date of the Explanation of Payment.  The most recent version of the form is on our website (using the link above), located in the Forms section.

New addresses for submitting appeals and reconsiderations

Effective immediately, please use our new email, fax and mail addresses for submitting appeals and reconsiderations.

For appeals:

Mail Stop 800

Community Health Options
PO Box 1121
Lewiston, ME 04243
appeals@healthoptions.org
Fax: 877-314-5693

For reconsiderations:

Mail Stop 800

Community Health Options
PO Box 1121
Lewiston, ME 04243
reconsiderations@healthoptions.org
Fax: 877-314-5693

Please use the most recent version of our claim reconsideration or appeal forms. Newly updated appeals and reconsideration forms with comprehensive instructions for their use can be found on our website (using the link above) in the Forms section.  Questions can be directed to Health Options Member Services at 855-624-6463.

SEE ALSO

If you are graduating, turning 26, or leaving a school-sponsored health insurance plan, you may be eligible for a Special Enrollment Period