Billing Guidelines for Claims Processing

This document is a guide issued by the Utilization Management Department of L.A. Care Health Plan, aimed at ensuring efficient claims processing for healthcare providers. It outlines critical billing reminders to help providers avoid unnecessary delays in claims processing. The guide emphasizes the importance of aligning authorization details with claims, including the necessity for the authorization number to match the services rendered, and for the dates of service to fall within the approved timeframe. It also highlights the requirement for the provider name and National Provider Identifier (NPI) on the claim to correspond with the approved authorization. Additionally, it details the importance of accurate Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS) codes and the need for correct billing practices to prevent delays. The document concludes with contact information for L.A. Care Provider Services for further assistance regarding claims and authorizations.