All claims should be submitted within 90 days from the date of service to avoid denial of the claim.
It is important when submitting claims to complete the member's and insured's name, PBH member identification number and the name of the subscriber's employer.
When the member is a dependent of a PBH insured, PBH will be requesting other insurance information from the insured. This may delay the processing of the claim. When PBH is secondary and no EOB from the primary carrier is attached to the claim, the PBH EOB will state that the claim has been denied. The provider can resubmit the claim with the appropriate EOB.
Claims must be re-submitted to the PBH Claims Department within 30 days of the denial.
Providers may not balance bill PBH members.
Submission of Claims
Be sure to include all information listed in the Required Billing Information section.
Submit claims to one of the following post office boxes:
Orange County Medi-Cal Claims Only: PacifiCare Behavioral Health, Inc. P.O. Box 31052 Laguna Hills, CA 92654-1052
NON-Medi-Cal Claims: PacifiCare Behavioral Health, Inc P.O. Box 31053 Laguna Hills, CA 92654-1053
Incomplete or inaccurate claims will result in unnecessary delays in payment or in claims being returned. Your cooperation in the PBH claims system assures you of timely claims payments and accurate and specific data collection by PBH which is fairly and appropriately represented to its clients and providers in re-negotiations.
Any questions regarding the approval and/or payment of claims should be directed to the Provider Helpline during business hours at (800) 716-1166.
Electronic Claims Submission
PBH is moving forward in our efforts to make available to providers electronic interfaces for claims submission. These include clearing houses, claims diskette submission and the use of the Internet. Currently monthly claims diskette submission is available for providers who wish to utilize this option. Use of clearing houses and the Internet should be available some time in the year 2001. For more information, please call the Provider Helpline at (800) 716-1166.
