 |
|
|
|
|
| |
Network Claims Processing
Claims for services rendered from the provider contract effective date
to termination date, as specified in the Service Fee Schedule must be
submitted electronically using the CMS 1500 (formerly HCFA 1500) to the
local Regional Behavioral Health Authority (RBHA).
Provider Claims submitted to the RBHA, when allowed and encountered
and reported to the Southwest Network by the RBHA as “Paid”, are reprocessed
to determine the appropriate reimbursement level in
accordance with your Service Fee Schedule.
The Southwest Network will compensate the Provider for covered services rendered
at rates specified in their Agreement within 30-45 days from receipt of
an encountered claim as reported on the Southwest Network Explanation of
Benefits.
Disputed claims should be mailed with a Southwest Network Disputed Claims
Request Form, a copy of the related Explanation of Payment and
applicable documentation for reconsideration.
|
|
|
|
|
