Participating Provider Claims Submission Guidelines 

Sample Claim Forms

CMS 1500 — Health Insurance Claim Form

CMS 1450 — UB-04 Uniform Bill

Corrected Claims Filing

to The Alliance to report modifications to a previously submitted claim.   The preferred manner for submitting corrected claims is via EDI.

To ensure that corrected claims are processed by The Alliance appropriately, please report claims as follows:

• For electronic 837 files: The Claim Frequency Code reported in Loop 2300 CLM05-3 should be reported as “7”
• For paper submitted claims: Indicate “Corrected Claim” at the top of the claim form

Additionally, please report the data fields as follows:

• UB Claims: Use the Type of Bill field with the 3rd digit reported as “7”
• CMS 1500 Claims: Field 22 should be reported as “7”

Failure to follow these guidelines may cause the claim to process and deny as a duplicate claim submission. Also submit the entire original claim with all line items and not just the line being corrected.

The Alliance will apply the contract provisions to the reported corrected claim and forward to the relevant TPA for processing. 

Tips for Quick Claims Turnaround

• Electronic claims submission are required for new contracts. Claims submitted electronically gain higher priority and are filed (and paid) faster than paper claims.
• Include provider name and degree in Box 31 of all CMS forms. The degree or education level of the servicing health care provider is required to reprice most claims.
• Confirm Alliance network status at each visit. Check a patient’s health plan ID card at each visit to ensure there haven’t been any changes in eligibility or employment status. A sample Alliance ID card provides a detailed explanation of the information to look for. Download an example of an Alliance ID card on this page.
• Enter names exactly as they appear on the ID card. Entering nicknames, such as “Shelly” when the ID card says “Michelle,” can cause an electronic claim to be rejected. Another common mistake is entering a name without punctuation, for example “John Smith Jones” when the ID card says “John Smith-Jones.”
• Enter member numbers exactly as they appear on the ID card. If your organization normally adds a two-digit suffix, please remove it before submitting the claim.
• If you don’t already, consider sending and receiving claims electronically. It’s the most efficient way to ensure you’re paid in the timeliest manner.

How to Determine the Status of a Claim

Need to determine the status of a previously submitted claim? Please do not submit a duplicate claim – it won’t result in returning the status of the claim and adds more costs and resources to the claims process.

Please proceed with one of the following options instead (in order of effectiveness):

• Contact the Third-Party Administrator (TPA) indicated on the patient’s ID card.
• Contact The Alliance Customer Service at 800.223.4139.
• Utilize The Alliance provider claims portal.