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 Southwest Network by the RBHA as
“Paid”, are reprocessed to determine the appropriate reimbursement
level in accordance with your Service Fee Schedule.

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 to Southwest
Network by the RBHA.

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.