Claim Tips for Paper Submissions

Date Issued: 1/1/2010

EmblemHealth and its companies, GHI and HIP, recommend electronic claims submission for its speed and accuracy. We are always improving electronic claims technology to enhance processing and payment of your claims. If you must send paper claims, an easily read, correct and complete claim can be automatically processed. We use scanning technology to "read" and enter your claims directly into our payment system. If claims that are not easy to read, correct or complete are submitted, claims processors must retype your claim(s) in the system. This process can result in a delay of claims payment.

The following suggestions will help us scan and pay your paper claims automatically:

• USE ONLY the RED-MARKED CMS PROFESSIONAL (CMS1500) and FACILITY (UB04) forms. These forms are specifically designed for scanning.
• DO NOT use a photocopy of a claim or fax claim(s) to us.
• DO NOT use forms prior to 2005. These are out of date.
• DO NOT include attachments on onionskin or other thin, tissue-like paper. Such paper can get caught or torn during the scanning process.
• DO NOT send a gray photocopy. If a photocopy is too light or too dark, the scanner will not be able to "read" the claim information. Any photocopy must be on white paper, not colored paper.
• DO NOT include attachments larger than 8.5x11 inches.
• USE UB04 facility claim forms for facility and hospital claims submissions.
• USE ONLY ONE STAPLE. If there are attachments, use only one staple to hold the entire submission package together. Multiple staples lead to tears during the scanning process and torn claims cannot be scanned.

Fonts, Format and Ink

• The ideal font is UPPER CASE lettering in 12-point Courier printed in black ink.
• The scanner does NOT recognize RED ink. Always use black ink to fill in your claims forms.
• Italicized fonts are not acceptable. The scanner cannot identify italicized fonts.
• AVOID using DOT MATRIX fonts.
• DO NOT hand write claim(s).
• DO NOT highlight any information on the claim form(s). Highlighting information will create a smudged image.

Ensure that all information is typed and appropriately aligned in the claim form box.