Paper Claims Submission FAQs
- What address do paper claims get mailed to?
- What claims forms can be used?
- What if I have a question about a paper claim?
- What information is needed when calling the claims help desk?
- What is the timely filing limit for claims submissions?
- How can a provider appeal an administrative denial?
Submit all paper claims to:
PerformCare of Pennsylvania
P.O. Box 7308
London, KY 40742
Depending on the service provided, one of two claim forms may be used:
- CMS 1500 is used for ambulatory services or services billed with a procedure code. Note: This form has been revised. For details on the new CMS 1500, please go to the National Uniform Claim Committee (NUCC) website.
- UB-04 should be used for inpatient or other services billed with a revenue code. For details on the UB-04, please go to the National Uniform Billing Committee (NUBC) website.
If you have any paper claims questions or problems, contact the claims help desk at 1-888-700-7370, option 1, 8 a.m. – 4:30 p.m., Monday – Friday.
- Caller's name and phone number.
- Provider's name.
- Claim number or member's Medical Assistance ID.
- CPT code and date of service.
Depending on the type of claims submission, the typical contract time frames are:
- Original submission — 60 days from the date of service.
- Third-party liability (TPL) submission — 60 days from the primary insurance explanation of benefits (EOB) date.
- Corrected claim — 180 days from the PerformCare EOB date.
Timeliness of claims involving TPL
Claims involving TPL must be submitted within 365 days of the date of service and no more than 60 days after the date of the EOB from the primary insurer. At least one level of appeal to the primary insurance is required when the primary insurer refuses to pay for a service due to a medical necessity denial before PerformCare will pay, regardless of how long it takes the primary insurer to respond. The EOB from the primary insurance must be submitted with the claim.
Inpatient admissions over 30 days
Providers of inpatient service will use a UB-04 claim form. Inpatient admissions resulting in a stay that exceeds 30 days will need to be billed on an interim basis to ensure timeliness of submission.
Timely filing is based on the dates of service, not the discharge date. Providers of ambulatory services will use the CMS 1500 for billing. UB-04 claims forms will not be accepted for billing ambulatory services. All invoices must be received within 60 days of the date of service to be considered for payment (unless other notification is provided related to specific contracts).
Reference the administrative appeal request form (PDF) for detailed instructions.