Claims Submission Resources
Claims must be filed within 180 days** of the date of service. You may submit either electronic or paper claims. Providers servicing Healthfirst NJ members should submit paper claims to:
P.O. Box 958436
Lake Mary, FL
**Timely filing for all out-of-network (OON) Medicare claims is 1 calendar year.
Healthfirst uses McKesson’s Intelliclaim software to review and edit claims submitted by affiliated providers, as appropriate. Guidelines are based on:
American Medical Association’s Current Procedural Terminology (CPT) Codes;
Centers for Medicare and Medicaid Services’ (CMS) Healthcare Common Procedure Coding System (HCPCS); and
CMS Correct Coding Initiative.
In addition to these standard coding edits, Healthfirst reviews preventive medicine counseling claims to ensure that the appropriate HIV counseling/screening diagnoses are submitted.
Healthfirst NJ Encourages Electronic Claims Submission
Healthfirst NJ encourages providers to file online and accepts both institutional and professional claims this way. Electronic filings are submitted through the Electronic Data Interchange (EDI) utilizing the Emdeon claims clearinghouse
. Contact your software vendor and request that your Healthfirst NJ claims be submitted through the Emdeon clearinghouse, or have your current clearinghouse forward your claims to Emdeon.
Providers who don't have claims submission software may sign up for a free on-line account with MD On-Line LINK
to begin filing electronically.
Each electronic claim must include:
Valid National Provider Identifier (NPI) residing in the appropriate system. Where should my NPI reside?
837 Professional (HCFA) - Loop 2310B Rendering Provider Secondary ID, Segment/Element NM109. NM108 must qualify with an XX (NPI).
837 Institutional (UB04) - Loop 2010AA Billing Provider, Segment/Element NM109. NM108 must qualify with an XX (NPI).
Healthfirst Payer ID Number 80141
Last update 2012-04-11 08:23