Claims Submission

Consult your copy of the Contracted Plan Summary to determine where you should send your claims for processing based on your client’s insurance plan. To avoid delay of payment, make sure you follow the plan requirements for claims submission.

Please follow these guidelines when filing a claim with HBI.

  • Bill normal charges for services rendered using CMS-1500 form
  • Make sure that all of the entries are accurate and complete
  • All claims must be received at HBI within 90 days from the date of service
  • If a claim is received after the 90-day cut off it may be denied
  • Make sure that your signature and title is on the CMS-1500 form.

If a claim is received at HBI and it doesn’t contain all of the information to process the claim, a letter will be sent to you explaining the information required to pay the claim. NO claims will be paid unless all information is documented on the CMS-1500 form.

Helpful information you might need to know when submitting a claim

Member Financial Responsibility

As a contracted provider, it is your responsible to determine what your patient’s financial obligations are based on their insurance plan.

  • You can refer to the Contracted Plan Summary to learn how to verify your client’s benefits, co-payments and deductibles.
  • Providers may collect the appropriate payment for the visit based on the member’s applicable deductible, co-insurance and/or co-pay. Providers may not collect more than the contracted fees.
  • Members are responsible for any non-covered benefits (i.e. taxes, non-covered testing, etc.)

Other very important information you need to know when submitting claims:

  • All claims are subject to eligibility & medical necessity at the time claims are received.
  • Obtaining prior authorization does NOT guarantee payment. A member may have exhausted his/her benefits, insurance may have termed, etc. at the time claims are filed and received.
  • Treatment of members must be performed by the credentialed provider that the referral was made by. You may not bill in your name when treatment is provided by another provider or assistant.
  • Patients referred to you may not be referred to another practitioner without authorization.
  • You may bill another insurance carrier at your usual and customary rate for non-covered services after the member’s benefits have been exhausted. However, any co-insurance a member pays must not exceed the difference between the amounts collected from the insurance carrier and the network’s negotiated rate.

For more information about claims processing, contact your client’s insurance plan.