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Claim Submission

All paper claims for healthcare services must be submitted on a properly completed CMS 1500 or UB04 claim form. All paper claims should be mailed to:

HealthCare Partners, IPA
Attn: Claims
1225 Franklin Avenue
Suite 100
Garden City, NY 11530

Electronic (EDI) Claims

• HCPIPA is able to accept claims via Electronic Data Interchange (EDI).
• HCPIPA’s EDI clearinghouse is Emdeon.
• HCPIPA’s Emdeon Payer ID number is 11328.
• In order to submit claims via EDI through Emdeon to HCPIPA, providers/suppliers must first establish an account.
• Emdeon will electronically transmit your claims to HCPIPA (as well as other commercial insurance carriers) free of charge to the provider/supplier. There is a nominal per claim charge for submission to government-sponsored insurance plans.
• To establish an account, contact Emdeon Business Services at 1-877-469-3263 option 3.
• To obtain a list of Emdeon Payer ID numbers for other payers who accept EDI claims visit www.emdeon.com.

Helpful HINTS For Successful Claim Submission

EDI Transmission

• HCPIPA may reject claims if the providers' Tax ID Number (TIN) is not in our system. Please verify that the TIN you are submitting is on file with HCPIPA. This is particularly important for providers using multiple TINs.
• Submit EDI claims with the providers full and proper name and National Provider Identifier (NPI) number. To apply for an NPI number, go to https://cms.hhs.gov
• Verify the Member health plan ID prior to transmission.
• Retain copies of your EDI transmission acceptance reports as evidence of transmission.
• If you have questions regarding electronic claims submissions, contact your HCPIPA Physicians Services Representative at 516-746-2200 or 888-746-2200.

Paper Claim

• Be sure to properly complete your claim form. Any missing or omitted information may lead to a delay in processing or rejection of your claim.
• Always include your Tax ID Number and NPI (National Provider Identification) number.
• For Medicare lines of business, Centers For Medicare and Medicaid Services (CMS) requires that ICD9 codes be submitted at the highest level of specificity. If a 4th or 5th digit is available it must be used. Failure to submit the most specific ICD9 code(s) may result in rejection of your claim.
• If your claim has been inadvertently misrouted and, as a result, is being submitted after the allowable filing time has expired, please include proof of timely filing with your resubmitted claim.