You are now leaving the WellSense website, and are being connected to a third party web site. Claims Refunds The following types of provider administrative claim appeals are IN SCOPE for this process: All documentation a provider wishes to have considered for a provider administrative appeal must be submitted at the time the appeal is filed. For all other uses, Level I Current Procedural Terminology (CPT-4) codes describe medical procedures and professional services. Health Net does not supply claim forms to providers. BMC HealthNet Plan | Provider Resources BMC HealthNet Plan is a non-profit managed care organization that has provided health insurance coverage to Massachusetts residents for more than 20 years. Write "Corrected Claim" and the original claim number at the top of the claim. Claims should be submitted within 90 days for Qualified Health Plans including ConnectorCare, and within 150 days for MassHealth and Senior Care Options. For earlier submissions and faster payments, claims should be submitted through our online portal or register with Trizetto Payer Solutions here. Download and complete the Request for Claim Review Form and submit with all required documents via Mail. If an issue cannot be resolved informally by a customer contact associate, Health Net offers its nonparticipating providers a dispute and appeal process. Clinical consultants who research, document, and provide edit recommendations based on the most common clinical scenario. To avoid possible denial or delay in processing, the above information must be correct and complete. Medicare CMS-1500 and CMS-1450 completion and coding instructions, are available on the Centers for Medicare & Medicaid Services (CMS) website. Providers are required to perform due diligence to identify and refund overpayments to BMC HealthNet Plan within 60 days of receipt of the overpayment. Circle all corrected claim information. Please do not hand-write in a new diagnosis, procedure code, modifier, etc. Identify the changes being made by selecting the appropriate option in the drop down menu.
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