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?

What address do paper claims get mailed to?

Submit all paper claims to:

PerformCare of Pennsylvania
HealthChoices
P.O. Box 7308
London, KY 40742

What claims forms can be used?

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.

What if I have a question about a paper claim?

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.

What information is needed when calling the claims help desk?

• Caller's name and phone number.
• Provider's name.
• Claim number or member's Medical Assistance ID. 
• CPT code and date of service.

What is the timely filing limit for claims submissions?

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 and within 365 days from date of service.
• Corrected claim — 365 days from the date of service.

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
PerformCare has removed this requirement and claims will no longer reject if the claim spans a calendar month. Providers will need to keep timely filing in mind and bill accordingly. Timely filing for primary claims is based on date of service not discharge date. However, remember claims cannot span a calendar year. This rule is for medical and hospital claims. Providers must bill separate claims when the date of service span over a calendar year. 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).

How can a provider appeal an administrative denial?

Reference the administrative appeal request form (PDF) for detailed instructions.

For requests related to primary claims denials:

• Explanations of benefits (EOBs) or denial letters from the primary insurer must be included.
• Appeal request must be submitted within 60 daysfrom PerformCare’s EOB date.