Ingham Health Plan EDI Claim Forms Guidelines
Ingham Health Plan EDI Claims should be sent directly to Emdeon (Ingham Health Plan clearinghouse). In order to to participate in electronic claims submission partnership with Ingham Health Plan your party must be a customer of Emdeon. Also your party can send Ingham Health Plan EDI Claims using the service of any clearinghouse. Below find Ingham Health Plan EDI Claims Guidelines for Form 1500 and Form UB-04.
Form 1500
Providers must use Medicaid approved HCPCS, CPT, Revenue, ICD-9, and modifier codes when completing EDI claims. Use of correct CHP member identification information, such as the insured’s ID (starts with the letters HPMS followed by six (6) digits) Date of birth, and spelling of member’s first and last name is also required.
Most clean claims are processed within 45 days of submission and reimbursed at State of Michigan Medicaid rates or higher. When submitting a CMS-1500 form, the following form locators must be completed or the claim will be denied:
Form Locator 1-13, 21, and 24 – 33. Providers should refer to the CHP and to the Medicaid Provider Manual for completion instructions. All other fields are optional.
Special attention should be given to the following form locators:
FL 1A: Member’s policy number. This number starts with the letters HPMS followed by six digits. It is not the member’s Recipient ID or Social Security number.
FL 23: Authorization number.
FL 24: Service information. Should be reported in the unshaded area. The shaded area is used to enter supplemental information which corresponds to the unshaded area.
FL 33A: Billing provider NPI. This number must be registered with the CHP prior to use and be assigned to the entity listed in box 33. Clink on “NPI information” under the quick links menu for more information.
Form UB-04
When submitting a UB-04 form, the following form locators must be completed or the claim will be denied:
Form Locator 1-28, 42-63, and 66–69. Providers should refer to the CHP and to the Medicaid Provider number for complete instructions. All other fields are optional.
Special attention should be given to the following form locators:
FL 1: Provider’s information.
FL 2: Pay To Information.
FL 4: Type of bill. Use Medicaid approved type of bill codes.
FL 60: Member’s policy number. This number starts with the letter HPMS followed by six digits. It is not the members Recipient ID or Social Security number.
FL 56: Billing provider NPI. This number must be registered with the CHP prior to use and be assigned to the entity listed in box 1. Click on “NPI information” under the quick links menu for more information.
FL 63: Authorization number (if applicable).