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Section 9: Claims
9.8 Incomplete or Invalid Claims
AHP is committed to timely processing of complete and accurate claims. All claims which are not complete will be denied and the denial code on the Explanation of Payment will indicate what information is necessary to reprocess the claim.
According to AHP policy, AHP will not make changes to claims thereby ensuring the integrity of claims processing. Policy on Corrected Claim Requests (PDF)
The following is a list of the most common reasons for which a corrected claim will be requested by AHP:
- Provider/Vendor name or address is illegible or Provider name is not listed in Item 31 on the claim form.
- Provider used initials in Item 31 on the claim form.
- If changes need to be made to any of the following fields on the claim:
- Charged amount, either total or by line (increase only)
- Dates of Service
- Diagnostic Related Group (DRG)
- Name of Provider
- Name of Vendor/Facility
- Tax Identification Number
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FASTER PAYMENTS
Did you know? The AHP system is set up to scan the claim and match the facility name listed in Item 33 to the facility name entered in our system. If this matches, the claim automatically adjudicates and the payment is processed.
If the provider’s name is listed, rather than the facility name, the claim does not automatically adjudicate and the claim is stopped for manual review, delaying payment processing. To improve the timeliness of claims payment, please be consistent in using the facility name in Item 33 on the CMS 1500 form.
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