Claims Submission Requirements for Professional Providers

This document is a guide detailing the claims submission requirements for professional providers under the Anthem Medicare Advantage program. It outlines the necessary information that must be included on the CMS-1500 Health Insurance Claim Form or its electronic equivalent for payment of healthcare services. The guide specifies that claims must meet authorization and medical necessity guidelines and must be submitted using compliant codes, including Current Procedure Terminology (CPT) codes and Healthcare Common Procedure Coding System (HCPCS) codes. It emphasizes that failure to provide the required information may result in claim denial or rejection. The document also notes that altered claims will be returned to the provider. Additionally, it highlights the preference for electronic claim submissions but states that paper claims are also accepted under specific conditions. Providers are encouraged to refer to their manuals and state-specific guidelines for further details on claims submission requirements.