Ayin strives to accept and process all received claims upon first receipt. We are providing you the following information to use as a guide for paper claim submission. Adhering to the information below will help to assure your paper claims are processed in a timely manner with quality, consistency, and compliance.
Preparing your claim(s) for submission:
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Ayin accepts the most current version of following claim forms:
- Professional HCFA FORM 1500
- Institutional UB - UB04 CMS 1450
- Dental - American Dental Association (ADA) Dental Claim Form
- Providing a correct and complete Plan/Carrier name on the claim form is required. Avoid indicating outdated or generic plan name data. Ayin will open all claim mail addressed to plans that we currently service. In accordance with US Code - Section 1702, all mail addressed to plans we do not service will not be opened and returned to the sender.
- All required fields of the paper claim form must be completed with valid data. It is essential that data entered on the claim aligns in the appropriate boxes.
- To assure our OCR scanning process functions with the highest level of accuracy, all claim forms must be the same size, scale, and alignment, as the standard professionally printed version of the form. Poorly aligned claims may result in unnecessary claim data rejections, or incorrect payments.
- Paper claims that are completely typed/printed are highly recommended.
- Handwritten claims are not recommended. Claims that are handwritten decrease the ability of the OCR scanning process to accurately read your submitted data and our ability to process it in a timely manner.
Attaching documentation to claims:
- Print documentation single-sided. Our OCR scanning systems are limited to single-sided scanning.
- Submit documentation on standard 8.5”x11” pages. Attached documentation that is not standard (8.5”x11”) size cannot be scanned and processed until extra handling is performed. This will delay processing of the claim. It is strongly encouraged that providers submit standard size documentation.
- In accordance with HIPAA, attachment documents may not contain information for individuals who are not the member indicated on the claim.