Claims Submission Checklist
Use the following checklist before submitting a claim to the fiscal agent for reimbursement.
Checklist
* Is the form typed or printed in black ink?
* Is the copy legible?
* Were instructions in the handbook followed? Some fields are not self explanatory or may be used for other purposes.
* Are the provider name(s) and number(s) entered?
* Is the claim signed and dated? Unsigned claims will be returned unprocessed.
* Are attachments required? Claims cannot be paid without the required attachments.
* Is the P.O. Box number for submitting the claim correct?
Claims Mailing Checklist
Introduction The following checklist may be used when mailing claims to the fiscal agent for
reimbursement.
Checklist
* Enclose only one claim type per envelope. Claims and adjustment requests
should be sent separately because they are processed separately by the
fiscal agent.
* The claims envelope should be addressed to the correct P.O. Box and
corresponding nine-digit zip code for each claim type being mailed.
Typewritten or machine-printed addresses speed up post office processing.
* Claims mailed in a large envelope or “flat” need to be marked “first class”
and paid for as first class postage. If first class is not specified, the post
office will send large envelopes as third class mail. This will delay delivery of
claims to the fiscal agent.
