Frequently Asked Questions

Reduce the time it takes to process your claim and avoid a returned claim by completely and correctly filling in the claim form.

The following items, if missing or incorrect, will delay processing of your claim or even result in a request for re-submission:

• Subscriber’s name
• Subscriber’s member ID number (11-digits)
• Patient’s name and date of birth
• Date of service
• UHA group number (4-digits)
• Name of referring physician for claims from laboratories, radiologists, and consultants
• Date, place, and cause of injury
• Descriptive diagnosis and ICD-9 code
• Descriptive procedures and CPT code
• Charges
• Provider’s billing name and address
• Provider or agent’s signature
• Supportive data for modifiers, e.g. after-hours modifier – claim should have time listed
• Provider Identification Number (PIN)
• Federal tax ID number

Avoid the following possible claims(s) denials:

• Claim submitted with Modifier -25 or -57?*
  • Tip: Submit your claims with supporting documentation indicating a significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service.
• Claim submitted with Modifier -59?*
  • Tip: Submit your claim with supporting documentation indicating the service was distinct or independent from other service(s) performed on the same day.
• Claim submitted with duplicate CPT codes?*
  • Tip: Submit your claim with supporting documentation indicating the service(s) is not a duplicate.
• UHA is secondary insurance carrier?*
  • Tip: Submit your claim with primary insurance carrier’s EOB (Explanation of Benefits)/RA (Remittance Advice).

*You may also apply this information for previously denied claims resubmitted for reimbursement reconsideration

Box 21 – DIAGNOSIS OR NATURE OF ILLNESS OR INJURY – ICD INDICATOR
Use the ICD-9 or ICD-10 code for each current diagnosis applicable to that visit. Do not put any description for each diagnosis code. The new form requires that codes be entered in the correct order following the alphabetical reference numbers (A-L) codes are entered left to right (alphabetical order), 4 codes per row, and up to 3 rows. NOTE: This is different from the old CMS form where only up to 4 codes can be entered and according to the numerical order.

UHA recommends that the diagnosis reference numbers (A-L) be used in COLUMN 24E to correspond with the services.

“ICD IND” Use this space to indicate if the diagnosis codes being used are ICD-9 or ICD-10 codes. An indicator of “9” would represent ICD-9 codes and a “0” indicator would represent ICD-10. This is a required field.

Please contact Customer Services if you require assistance.​

Here are three common reasons a claim may be denied and some helpful tips to get your claims paid without delay:

1. Denial Reason: “Duplicate claim”:
   • Check other claims to see if the service was paid on another claim;
   • If the service in question was not paid on another claim:
     • Do NOT resubmit the same claim.
     • Instead, submit the Provider Claims Action Request form with clinical notes.
2. Denial Reason: “Exceeded timely filing”:
   • Submit the Timely Claim Filing Waiver Form for providers with supporting documentation.
3. Denial Reason: “No Prior Authorization on file”:
   • Submit the Prior Authorization Request Form for appropriate services with clinical notes for retroactive review:
     • Prior Authorization for Medical Services
     • Prior Authorization for Prescription Drugs
   • Reference list of Services That Require Prior Authorization

Acceptable reasons for timely filing waivers:

• Claim submission within 12 months from date of service
• Claim submission within 12 months from date of denial
• Claim submission within 12 months from newborn enrollment
• Claim submission within 12 months from primary carrier’s payments
• Claim submission within 12 months of third party liability payer exhaust denial (must provide dated denial)

If none of the above reasons apply, a Claim Filing Waiver Form may be submitted with one of the following documents that support attempts of earlier claims submissions:

• Copy of the electronic claim denial/rejection notification
• Dated correspondence from UHA with claim information detailing why claim was rejected
• Dated confirmation of claim receipt

When requesting a waiver, please use the Timely Claim Filing Waiver Form.

If you have any questions regarding timely filing, please contact Customer Services at (808) 532-4000, extension 351, from Oahu or (800) 458-4600, extension 351, from the neighbor islands.

1. What should you do if you are asked to resubmit a claim with notes?
   • Submit a paper claim with medical notes attached and write “Resubmission” at the top right hand corner.
2. What should you do if there is a denial on your claim that you disagree with?
   • Complete and submit a “Claim Reconsideration Request” form along with your medical notes.
   • Do not submit a claim with the “Claim Reconsideration Request” form to avoid a duplicate claim denial.
3. What should you do if you would like to make a correction on a previously submitted claim?
   • Submit a paper claim and write the words “Corrected Claim” at the top right hand corner.
   • Please ensure that the corrected claim matches your original claim with the exception of the area(s) that is being corrected.See example below:

Original Claim

Corrected Claim

(Line 1: CPT changed to 99213 / Lines 2 & 3 identical to original claim)