In The News

An internal claims audit revealed that the prior authorization number (entered on a CMS 1500 claim form) and the treatment authorization number (entered on a UB04 claim form) are not being submitted on the original claim submission when authorization is required for services rendered. This is causing an increase of corrected claim submissions.

As a reminder, a complete claim submission must include all the relevant information to be processed for correct and timely payment. Failure to submit a complete claim will ultimately cause a delay in payment.

To ensure timely and correct payment for services rendered, please submit claims with the appropriate authorization number on the original claim.

Billing tips have been provided below, but additional information can also be found on the Provider Billing and Resource Guide https://www.hpsj-mvhp.org/provider-billing-and-resource-guide/.

Billing Tips

CMS 1500 Professional Claims Field 23

UB04 Institutional Claims Field 63

Electronic – Professional claims (837P) REF02 when REF01=’G1’ in Header Loop 2300 or Line Loop 2400

• If no authorization is required, leave the prior authorization or treatment authorization field blank. Entering any information other than a valid authorization will result in claim denial.
• DO NOT submit a claim with a hardcopy of an authorization attached to the claim form (CMS-1500 or UB-04)

Should you have any further questions, please contact our Customer Services Department at (209) 942‐6320. You may also visit https://www.hpsj-mvhp.org/alerts/ for online access to the documents shared. The most recent information about Health Plan of San Joaquin and our services is always available on our website https://www.hpsj-mvhp.org/.