{"id":2138,"date":"2025-01-06T15:53:16","date_gmt":"2025-01-06T23:53:16","guid":{"rendered":"https:\/\/www.qualityhealth.org\/adminsimp\/?page_id=2138"},"modified":"2025-01-06T15:57:36","modified_gmt":"2025-01-06T23:57:36","slug":"claims-processing-policies-and-guidelines","status":"publish","type":"page","link":"https:\/\/www.qualityhealth.org\/adminsimp\/claims-processing-policies-and-guidelines\/","title":{"rendered":"Claims Processing Policies and Guidelines"},"content":{"rendered":"<p>A series of projects have been completed with the goal of reducing the amount of paper providers send to health plans, thereby reducing staff time and speeding payment.<\/p>\n<h3>Submitting Corrected Claims<\/h3>\n<p>Fields on form can be typed for clarity before printing.<\/p>\n<p><a href=\"http:\/\/www.qualityhealth.org\/adminsimp\/wp-content\/uploads\/sites\/25\/2025\/01\/Corrected_Claims_Cover_Sheet_ver35_form1.pdf\">Corrected Claims Cover Sheet <\/a>(.pdf\u00a0| 64k\u00a0| Rev 3.5\u00a0| 5\/2011)<\/p>\n<p><a href=\"http:\/\/www.qualityhealth.org\/adminsimp\/wp-content\/uploads\/sites\/25\/2025\/01\/Guidelines_Submitting_Corrected_Claims1.pdf\">Corrected Claims Guideline Document<\/a>\u00a0(.pdf\u00a0| 135k\u00a0| Rev 4.2\u00a0| 5\/2011)<\/p>\n<h3>Submitting Supporting Documentation<\/h3>\n<p>Fields on form can be typed for clarity before printing.<\/p>\n<p><a href=\"http:\/\/www.qualityhealth.org\/adminsimp\/wp-content\/uploads\/sites\/25\/2025\/01\/CoverSheet-SupportingDocumentation_TBU_10071.pdf\">Supporting Documentation Cover Sheet<\/a>\u00a0(.pdf\u00a0| 127k\u00a0| Rev 10.09 | 08\/23)<\/p>\n<p><a href=\"http:\/\/www.qualityhealth.org\/adminsimp\/wp-content\/uploads\/sites\/25\/2025\/01\/Guideline-SubmittingSupportingDocumentation_TBP_10071.pdf\">Supporting Documentation Guideline Document<\/a>\u00a0(.pdf\u00a0| 33k\u00a0| Version 10.8\u00a0| 10\/07)<\/p>\n<h3>Conditions for Splitting Claims<\/h3>\n<p>Clarifies the eight most common conditions under which claims are split.<\/p>\n<p><a href=\"http:\/\/www.qualityhealth.org\/adminsimp\/wp-content\/uploads\/sites\/25\/2025\/01\/Statement_of_Clarification-Splitting_Claims_01.pdf\">Guideline Document<\/a>\u00a0(.pdf\u00a0| 11.26.13)<\/p>\n","protected":false},"excerpt":{"rendered":"A series of projects have been completed with the goal of reducing the amount of paper providers send to health plans, thereby reducing staff time and speeding payment. Submitting Corrected Claims Fields on form can be typed for clarity before printing. Corrected Claims Cover Sheet (.pdf\u00a0| 64k\u00a0| Rev 3.5\u00a0| 5\/2011) Corrected Claims Guideline Document\u00a0(.pdf\u00a0| 135k\u00a0|&#8230;","protected":false},"author":132,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"class_list":["post-2138","page","type-page","status-publish","hentry"],"aioseo_notices":[],"aioseo_head":"\n\t\t<!-- All in One SEO 4.9.10 - aioseo.com -->\n\t<meta name=\"robots\" content=\"max-image-preview:large\" \/>\n\t<link rel=\"canonical\" href=\"https:\/\/www.qualityhealth.org\/adminsimp\/claims-processing-policies-and-guidelines\/\" \/>\n\t<meta name=\"generator\" content=\"All in One SEO (AIOSEO) 4.9.10\" \/>\n\t\t<meta property=\"og:locale\" content=\"en_US\" \/>\n\t\t<meta property=\"og:site_name\" content=\"Administrative Simplifications | Foundation For Health Care Quality\" \/>\n\t\t<meta property=\"og:type\" content=\"article\" \/>\n\t\t<meta property=\"og:title\" content=\"Claims Processing Policies and Guidelines | Administrative Simplifications\" \/>\n\t\t<meta property=\"og:url\" content=\"https:\/\/www.qualityhealth.org\/adminsimp\/claims-processing-policies-and-guidelines\/\" \/>\n\t\t<meta property=\"article:published_time\" content=\"2025-01-06T23:53:16+00:00\" \/>\n\t\t<meta property=\"article:modified_time\" content=\"2025-01-06T23:57:36+00:00\" \/>\n\t\t<meta name=\"twitter:card\" content=\"summary\" \/>\n\t\t<meta name=\"twitter:title\" content=\"Claims Processing Policies and Guidelines | Administrative Simplifications\" \/>\n\t\t<script type=\"application\/ld+json\" class=\"aioseo-schema\">\n\t\t\t{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/www.qualityhealth.org\\\/adminsimp\\\/claims-processing-policies-and-guidelines\\\/#breadcrumblist\",\"itemListElement\":[{\"@type\":\"ListItem\",\"@id\":\"https:\\\/\\\/www.qualityhealth.org\\\/adminsimp#listItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/www.qualityhealth.org\\\/adminsimp\",\"nextItem\":{\"@type\":\"ListItem\",\"@id\":\"https:\\\/\\\/www.qualityhealth.org\\\/adminsimp\\\/claims-processing-policies-and-guidelines\\\/#listItem\",\"name\":\"Claims Processing Policies and Guidelines\"}},{\"@type\":\"ListItem\",\"@id\":\"https:\\\/\\\/www.qualityhealth.org\\\/adminsimp\\\/claims-processing-policies-and-guidelines\\\/#listItem\",\"position\":2,\"name\":\"Claims Processing Policies and Guidelines\",\"previousItem\":{\"@type\":\"ListItem\",\"@id\":\"https:\\\/\\\/www.qualityhealth.org\\\/adminsimp#listItem\",\"name\":\"Home\"}}]},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/www.qualityhealth.org\\\/adminsimp\\\/#organization\",\"name\":\"Administrative Simplifications\",\"description\":\"Foundation For Health Care Quality\",\"url\":\"https:\\\/\\\/www.qualityhealth.org\\\/adminsimp\\\/\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.qualityhealth.org\\\/adminsimp\\\/claims-processing-policies-and-guidelines\\\/#webpage\",\"url\":\"https:\\\/\\\/www.qualityhealth.org\\\/adminsimp\\\/claims-processing-policies-and-guidelines\\\/\",\"name\":\"Claims Processing Policies and Guidelines | Administrative Simplifications\",\"inLanguage\":\"en-US\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.qualityhealth.org\\\/adminsimp\\\/#website\"},\"breadcrumb\":{\"@id\":\"https:\\\/\\\/www.qualityhealth.org\\\/adminsimp\\\/claims-processing-policies-and-guidelines\\\/#breadcrumblist\"},\"datePublished\":\"2025-01-06T15:53:16-08:00\",\"dateModified\":\"2025-01-06T15:57:36-08:00\"},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/www.qualityhealth.org\\\/adminsimp\\\/#website\",\"url\":\"https:\\\/\\\/www.qualityhealth.org\\\/adminsimp\\\/\",\"name\":\"Administrative Simplifications\",\"description\":\"Foundation For Health Care Quality\",\"inLanguage\":\"en-US\",\"publisher\":{\"@id\":\"https:\\\/\\\/www.qualityhealth.org\\\/adminsimp\\\/#organization\"}}]}\n\t\t<\/script>\n\t\t<!-- All in One SEO -->\n\n","aioseo_head_json":{"title":"Claims Processing Policies and Guidelines | Administrative Simplifications","description":"","canonical_url":"https:\/\/www.qualityhealth.org\/adminsimp\/claims-processing-policies-and-guidelines\/","robots":"max-image-preview:large","keywords":"","webmasterTools":{"miscellaneous":""},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"BreadcrumbList","@id":"https:\/\/www.qualityhealth.org\/adminsimp\/claims-processing-policies-and-guidelines\/#breadcrumblist","itemListElement":[{"@type":"ListItem","@id":"https:\/\/www.qualityhealth.org\/adminsimp#listItem","position":1,"name":"Home","item":"https:\/\/www.qualityhealth.org\/adminsimp","nextItem":{"@type":"ListItem","@id":"https:\/\/www.qualityhealth.org\/adminsimp\/claims-processing-policies-and-guidelines\/#listItem","name":"Claims Processing Policies and Guidelines"}},{"@type":"ListItem","@id":"https:\/\/www.qualityhealth.org\/adminsimp\/claims-processing-policies-and-guidelines\/#listItem","position":2,"name":"Claims Processing Policies and Guidelines","previousItem":{"@type":"ListItem","@id":"https:\/\/www.qualityhealth.org\/adminsimp#listItem","name":"Home"}}]},{"@type":"Organization","@id":"https:\/\/www.qualityhealth.org\/adminsimp\/#organization","name":"Administrative Simplifications","description":"Foundation For Health Care Quality","url":"https:\/\/www.qualityhealth.org\/adminsimp\/"},{"@type":"WebPage","@id":"https:\/\/www.qualityhealth.org\/adminsimp\/claims-processing-policies-and-guidelines\/#webpage","url":"https:\/\/www.qualityhealth.org\/adminsimp\/claims-processing-policies-and-guidelines\/","name":"Claims Processing Policies and Guidelines | Administrative Simplifications","inLanguage":"en-US","isPartOf":{"@id":"https:\/\/www.qualityhealth.org\/adminsimp\/#website"},"breadcrumb":{"@id":"https:\/\/www.qualityhealth.org\/adminsimp\/claims-processing-policies-and-guidelines\/#breadcrumblist"},"datePublished":"2025-01-06T15:53:16-08:00","dateModified":"2025-01-06T15:57:36-08:00"},{"@type":"WebSite","@id":"https:\/\/www.qualityhealth.org\/adminsimp\/#website","url":"https:\/\/www.qualityhealth.org\/adminsimp\/","name":"Administrative Simplifications","description":"Foundation For Health Care Quality","inLanguage":"en-US","publisher":{"@id":"https:\/\/www.qualityhealth.org\/adminsimp\/#organization"}}]},"og:locale":"en_US","og:site_name":"Administrative Simplifications | Foundation For Health Care Quality","og:type":"article","og:title":"Claims Processing Policies and Guidelines | Administrative Simplifications","og:url":"https:\/\/www.qualityhealth.org\/adminsimp\/claims-processing-policies-and-guidelines\/","article:published_time":"2025-01-06T23:53:16+00:00","article:modified_time":"2025-01-06T23:57:36+00:00","twitter:card":"summary","twitter:title":"Claims Processing Policies and Guidelines | Administrative Simplifications"},"aioseo_meta_data":{"post_id":"2138","title":null,"description":null,"keywords":null,"keyphrases":{"focus":{"keyphrase":"","score":0,"analysis":{"keyphraseInTitle":{"score":0,"maxScore":9,"error":1}}},"additional":[]},"primary_term":null,"canonical_url":null,"og_title":null,"og_description":null,"og_object_type":"default","og_image_type":"default","og_image_url":null,"og_image_width":null,"og_image_height":null,"og_image_custom_url":null,"og_image_custom_fields":null,"og_video":"","og_custom_url":null,"og_article_section":null,"og_article_tags":null,"twitter_use_og":false,"twitter_card":"default","twitter_image_type":"default","twitter_image_url":null,"twitter_image_custom_url":null,"twitter_image_custom_fields":null,"twitter_title":null,"twitter_description":null,"schema":{"blockGraphs":[],"customGraphs":[],"default":{"data":{"Article":[],"Course":[],"Dataset":[],"FAQPage":[],"Movie":[],"Person":[],"Product":[],"ProductReview":[],"Car":[],"Recipe":[],"Service":[],"SoftwareApplication":[],"WebPage":[]},"graphName":"WebPage","isEnabled":true},"graphs":[]},"schema_type":"default","schema_type_options":null,"pillar_content":false,"robots_default":true,"robots_noindex":false,"robots_noarchive":false,"robots_nosnippet":false,"robots_nofollow":false,"robots_noimageindex":false,"robots_noodp":false,"robots_notranslate":false,"robots_max_snippet":"-1","robots_max_videopreview":"-1","robots_max_imagepreview":"large","priority":null,"frequency":"default","local_seo":null,"breadcrumb_settings":null,"limit_modified_date":false,"ai":null,"created":"2025-01-06 23:49:18","updated":"2026-01-17 09:12:40","seo_analyzer_scan_date":null},"aioseo_breadcrumb":"<div class=\"aioseo-breadcrumbs\"><span class=\"aioseo-breadcrumb\">\n\t\t\t<a href=\"https:\/\/www.qualityhealth.org\/adminsimp\" title=\"Home\">Home<\/a>\n\t\t<\/span><span class=\"aioseo-breadcrumb-separator\">\u00bb<\/span><span class=\"aioseo-breadcrumb\">\n\t\t\tClaims Processing Policies and Guidelines\n\t\t<\/span><\/div>","aioseo_breadcrumb_json":[{"label":"Home","link":"https:\/\/www.qualityhealth.org\/adminsimp"},{"label":"Claims Processing Policies and Guidelines","link":"https:\/\/www.qualityhealth.org\/adminsimp\/claims-processing-policies-and-guidelines\/"}],"_links":{"self":[{"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/pages\/2138","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/users\/132"}],"replies":[{"embeddable":true,"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/comments?post=2138"}],"version-history":[{"count":3,"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/pages\/2138\/revisions"}],"predecessor-version":[{"id":2143,"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/pages\/2138\/revisions\/2143"}],"wp:attachment":[{"href":"https:\/\/www.qualityhealth.org\/adminsimp\/wp-json\/wp\/v2\/media?parent=2138"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}