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Claims that are submitted with incomplete or erroneous information can influence turn-a-round time that may result in delayed payment. Midlands Choice has identified some trends and processes that may help offices submit claims successfully.

• It is important to obtain a current member identification card for the patient prior to providing services.
• Register for access to the Midlands Choice secure website. Registered users can look up employer group information to determine the correct group number to submit on the claim form and whether or not the employer group is active with a Midlands Choice payer.
• If a group has terminated with Midlands Choice, contact the patient for the current insurance information.
• Always include the group number from the patient's member identification card on the claim. Claims submitted without a group number are returned to the provider.
• Claims submitted with "NGN" (no group number) will also be returned to the provider.
• Look for the Midlands Choice logo on the patient identification card to determine that the patient is a member of a group that accesses the Midlands Choice network.
• Contact the payer or claims administrator for eligibility information. Contact information for the payer can be found on the patient's member identification card. Midlands Choice does not have member eligibility or benefit information.

 

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