Providers (e.g., hospitals, skilled nursing facilities, home health agencies, and physicians) and suppliers are generally contracted to file claims for covered services and supplies that you receive. You should not need to file claims. Providers should be aware of any filing period limitations under your plan in which claims must be filed for the services or supplies provided (e.g., 180 days from date of service or purchase, within one calendar year from date of service, etc). There are times when members must submit a claim directly to their medical plan.
FORMS: Members should contact member services (listed on the insurance ID card) about which form or documentation is required (e.g., HCFA1500 claim form, health benefit claim form, manufacturer or supplier invoice, physician’s order, etc)
HCFA1500: Members should complete as much information as they can. Be sure to sign the appropriate boxes (see example). Members will need to know the following:
1. HCPCS or Billing Code (ie. B4086, B9998, etc.)
2. ICD-9 or Diagnosis Code
Health Benefit Claim Form:
Your particular medical plan may have specific forms for their members to file. Contact member services listed on your insurance card for more information.
INVOICE: Some medical plans only require the member to submit a copy of their purchase receipt or the manufacturer or supplier invoice. To ensure your claim is processed accurately and timely, members should be sure to have the following information on the invoice:
1. Complete description of the medical supply
2. HCPCS or Billing Code (ie. B4086, B9998, etc.)
3. ICD-9 or Diagnosis Code (contact your physician)
CLAIM ADDRESS: Your insurance card should supply a claims address. If not, contact member or customer service at the toll-free number listed on the insurance card. Be sure to sign claim forms, if applicable, and attach invoice or other documentation necessary for your insurance to process your claim correctly.
IF THE CLAIM IS DENIED OR NOT REIMBURSED: As a member, you have the right to request a review of the denied claim or file a grievance in which you do not agree with how your claim was processed. To do this, you must contact member services, listed on your insurance card. You will need the following information:
1. Your Policy or Contract ID Number
2. Date of Service or Purchase Date supply was billed under
3. Amount or charge submitted on claim
4. Name of medical supplier
MIC-KEY* Reimbursed Products
Contact Avanos Customer Service at 1-844-4Avanos (1-844-428-2667) to find out to how purchase MIC-KEY* enteral feeding tubes.