PacifiCare Behavioral Health is committed to prompt and accurate claims payment. In order to achieve this result, PBH relies on providers to submit accurate claims.
The PBH claims system is rule-based. This means payment of claims relies heavily on whether or not the claim form fulfills the rules for payment. The process is very simple, if you remember these things:
Pre-Authorization
All services (including psychological testing) must be pre-authorized in order to receive payment. Services billed must match services authorized by:
Service type (diagnosis and procedural)
Valid service dates
Number of authorized services
Tax ID of provider performing services
Accurate and Complete Claim Forms
To ensure timely, accurate payment, all practitioner bills must be submitted on 1500 Health Insurance Claim Form (HICF). All required information for the 1500 HICF is addressed on the next page. Facilities must submit bills on UB92 forms.
Timely Claims Submission
All claims must be submitted within 90 days from the date of service.
Facility bills must be held until the fully authorized course of treatment has been completed and the member has been discharged or has discontinued authorized treatment. The fully authorized course of treatment includes all extensions and transfers to different levels of care within the facility.
