Community First Health Plans (Community First) would like to remind providers of the billing requirements for inpatient claims totaling $10 million or more. To ensure proper claims processing, these claims must be split into multiple submissions, with each interim claim totaling less than $10 million and billed using the appropriate Type of Bill (TOB).
Required Billing Guidelines
Please follow the guidelines below to avoid processing delays or denials:
- First Interim Claim (TOB 112): Submit the initial claim covering the admission date through the current “through” date. Must include discharge disposition code 30.
- Subsequent Interim Claims (TOB 113): Submit as needed to report additional inpatient charges. Must include all dates of service (admission date through current “through” date) and discharge disposition code 30.
- Final Discharge Claim (TOB 114): Submit the final claim upon discharge. Must include the entire admission (admit date through discharge date) and a discharge disposition other than 30.
Important Reminder
Providers are required to submit at minimum one First Interim Claim (TOB 112) and one Final Discharge Claim (TOB 114). Failure to follow these billing guidelines may result in claim denials.
Action:
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.
To access all Provider alerts:
- Log into the Community First Provider Portal
- Go to CommunityFirstHealthPlans.com/Provider-News
- Sign up for the Community First Provider eNewsletter