Fall 2017
- It is not necessary to provide a W-9 form with a claim unless it is the first time a claim is submitted to Neighborhood on a provider’s behalf.
- Data entered on the claim form must be properly aligned and fall completely within the applicable text fields. Data that is misaligned or ghosted elsewhere on the form is systematically recognized as an error and will result in the claim being returned to the sender for correction.
- Claim forms must not contain any handwritten elements, stamps, correction fluid, or staples.
- Neighborhood uses technology to scan paper forms and eliminate keystroke errors. All new and corrected claims must be submitted on original (not photocopied) print versions of the industry standard CMS-1500 and CMS-1450 (UB-04) forms, as they are printed in special optical character recognition (OCR)-scannable red ink.
- Please do not drop off claims at any of Neighborhood’s locations, as there is no way to track them for inclusion in the daily mail process. All claims should be mailed to:
Neighborhood Health Plan of Rhode Island
PO Box 28259
Providence, RI 02908-3700
Adjustment Requests
When submitting a request for a claim adjustment, please do not submit the claim. Adjustment requests require the submission of a completed Adjustment Request Form, applicable claim number, and Remittance Advice, Explanation of Benefits, and/or Coordination of Benefits documentation, as applicable. Adjustment requests submitted with claims attached will be returned to the sender.
Outline.