Instruction and Guide: correct process of claim submission


correct process of claim submission

General Procedures

Verify eligibility through the Voice Response System (VRS), Internet, Provider Electronic Solutions or swipe card reader.
• File claims within time limits specified in the General Policy Section of this manual.
• Use only original CMS-1500 forms with red drop-out ink.
• Include only what is required in Section 2.3 (e.g., no stickers, no stamps, no unnecessary handwritten comments).
• Ensure that all claims submitted for Medical Assistance payment are signed in black ink or a signed Trading Partner Agreement is on file at EDS.
• Ensure that handwritten claims are completed using black ink.
• Ensure that all required inclusions are submitted, e.g., Explanation of Medical Benefits (EOMB) from third-party insurance coverage.
• Mail the completed claims to the following address:

P.O. Box 909, Manor Branch
New Castle, DE 19720-0909