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Claims and Payment Policy Program Requirements __________________________________________________________
Hometown Health Claims Processing
Hometown Health Reimbursement Services is dedicated to ensure accurate and timely processing of all claims pursuant to the member ’ s benefit plan and individual provider contracts .
As you know , efficient billing is essential to the successful operation of any physician office , hospital , or ancillary medical provider . By properly completing your claim , your office can minimize the time spent on billing and help speed payment to your office .
Complying with all requirements of Hometown Health ’ s Utilization Management Program and verifying the member ’ s eligibility for benefits will help your claims to be processed timely and accurately .
Claim Filing Time Limits Hometown Health allows 365 days from the date of service to submit a claim for payment .
Please remember to check Link regularly to confirm that we have received your claim and to determine the status .
For all claims submissions , but particularly paper claims , please pay particular attention to the following items :
• Member ’ s name and enrollee identification number exactly as they appear on the member ’ s identification card
• Member ’ s birth date
• Provider ’ s Taxpayer Identification Number – Do not use a signature stamp that in any way obscures the Tax Identification Number ( TIN )
• Provider ’ s National Provider Identifier and / or servicing provider ’ s National Provider Identifier ( NPI ) on the CMS-1500
• Accurate coding of all diagnoses and services in accordance with national coding guidelines will help us accurately determine a member ’ s level of coverage under his or her benefit plan for certain services .
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