Fill Out Your Maryland State Claim Template

When filling out the Maryland State Claim form, here are some important dos and don’ts:

• Do ensure all questions are answered completely.
• Do use one claim form per patient.
• Do attach itemized bills from the provider.
• Do keep a copy of your submitted claim for your records.
• Don’t submit claims without the required supporting documents.
• Don’t forget to check if the patient has other insurance coverage.
• Don’t leave any sections of the form blank.
• Don’t submit bills in a foreign language without translation.

When it comes to the Maryland State Claim form, several misconceptions can lead to confusion among users. Here are seven common misunderstandings explained clearly.

• Only participating providers can be billed. Many believe that claims can only be filed for services from participating providers. However, you can file claims for non-participating providers as well.
• All claims can be submitted without itemized bills. Some think that submitting the claim form alone is sufficient. In reality, you must attach itemized bills that provide detailed information about the services received.
• Claims can be filed without all sections completed. A common myth is that incomplete forms are acceptable. To avoid delays, every section of the claim form must be filled out completely.
• Medicare coverage is not relevant for claims. Some users may overlook the importance of Medicare information. If you have Medicare, it is crucial to provide this information, as it can affect how your claim is processed.
• Only one claim form is needed for multiple patients. Many believe they can use one claim form for multiple patients. In fact, you must submit a separate claim form for each patient to ensure proper processing.
• Foreign bills do not need translation. Some assume that bills in foreign languages are acceptable as is. However, they must be translated into English, and any foreign currency should be converted to U.S. dollars.
• Claims can be submitted without proof of prior payments. There is a misconception that you can submit claims without including payment statements from other insurance carriers. If another insurer is involved, you must include their payment statement to facilitate the claims process.

Understanding these misconceptions can help ensure that your claims are processed smoothly and efficiently. Always double-check the requirements and provide all necessary documentation to avoid any issues.

Filling out the Maryland State Claim form requires attention to detail and accuracy. Here are key takeaways to keep in mind:

• Complete Information: Ensure all sections of the form are filled out completely. Missing information can delay processing.
• Subscriber and Patient Details: Clearly provide the subscriber’s and patient’s legal names, along with their relationship to each other.
• Illness and Treatment Information: List all illnesses and dates of first symptoms for which you are submitting claims.
• Accident Information: If the treatment is related to an accident, include details such as the date and location of the accident.
• Medicare Coverage: Indicate if the patient has Medicare and provide effective dates for both Part A and Part B if applicable.
• Other Insurance: If the patient has additional health insurance, provide relevant details including policyholder information and coverage type.
• Itemized Bills Required: Attach itemized bills that include the provider’s details, services rendered, and amounts charged.
• Translations and Currency: Bills in foreign languages must be translated to English, and foreign currency should be converted to U.S. dollars.
• Signature and Certification: The subscriber must sign and date the form, certifying that the information provided is accurate.

By following these guidelines, you can facilitate a smoother claims process and ensure that all necessary information is provided for timely reimbursement.

1. Incomplete Information: Failing to fill out all required fields can lead to delays in processing. Ensure that each section of the form is completed, including the subscriber's and patient's legal names, membership number, and relationship to the subscriber.

2. Incorrect Dates: Providing incorrect dates for treatment or the patient’s date of birth can result in claim denials. Double-check all dates for accuracy before submission.

3. Missing Signatures: Not signing the form is a common oversight. The subscriber must sign and date the claim form to validate the information provided.

4. Not Attaching Itemized Bills: Failing to include itemized bills can lead to immediate rejection of the claim. Ensure all necessary documentation is attached, including provider details and service descriptions.

5. Overlooking Other Insurance: If the patient has other health insurance coverage, neglecting to disclose this information can complicate the claim process. Always indicate if there is additional coverage and provide relevant details.

6. Using One Claim Form for Multiple Patients: Submitting claims for multiple patients on a single form is not permitted. Use a separate claim form for each patient to avoid confusion and ensure proper processing.

7. Ignoring Special Instructions: Certain services, such as office visits or durable medical equipment, require additional information. Failing to provide this can delay claims. Review the instructions carefully and include all necessary details.

8. Not Keeping Copies: Many individuals forget to keep copies of their submitted claims and bills. Retaining copies can be essential for future reference or in case of disputes.

9. Submitting Claims Late: Each claim has a specific timeframe for submission. Delaying the submission can lead to rejection. Be aware of the deadlines and submit claims promptly.

What is the Maryland State Claim form used for?

The Maryland State Claim form is specifically designed for members of the State Employees Health Plan to file claims for health care services. This includes claims for services rendered by non-participating providers, as participating providers typically bill CareFirst BlueCross BlueShield directly. If you’ve received care from a provider who doesn’t participate in the plan, you’ll need to use this form to submit your claim for reimbursement.

What information do I need to complete the claim form?

To successfully complete the claim form, you will need to provide essential information such as the subscriber's and patient's legal names, membership number, address, and date of birth. Additionally, you must list the illnesses or injuries for which you are claiming, the dates of first symptoms, and whether the treatment was related to an injury or an automobile accident. Make sure to answer all questions accurately to avoid delays in processing your claim.

What types of bills should I attach to my claim?

When submitting your claim, you must attach itemized bills that include specific details. These bills should have the provider’s full name, address, phone number, and CareFirst provider number if available. Each bill must clearly describe the services provided, the dates of service, the diagnosis or chief complaint, and the amounts charged. Bills in a foreign language should be translated to English, and any foreign currency must be converted to U.S. dollars.

Do I need to submit a separate claim form for each patient?

Yes, it is important to use one claim form per patient. This ensures that each claim is processed accurately and efficiently. If you are filing claims for multiple family members, make sure to complete a separate form for each individual to avoid confusion.

What if another insurance carrier is involved?

If another insurance carrier, including Medicare, is paying for part of your claim, you must submit a copy of their payment statement along with your claim. This statement is often referred to as an "Explanation of Benefits" or "Summary of Benefits." Including this documentation helps CareFirst coordinate benefits and process your claim correctly.

What additional information is required for certain services?

For specific services, additional information is necessary. For example, office visits should indicate the type of visit (brief, intermediate, extended). For durable medical equipment, a letter of medical necessity from your physician must be included. If your claim involves accidental injury, the date of the accident must be clearly stated. Always check the guidelines to ensure you have all required information for the services you are claiming.

How do I ensure my claim is processed quickly?

To facilitate a quick processing time, ensure that you fill out the claim form completely and accurately. Attach all required documentation, including itemized bills and any necessary supporting statements. It’s also wise to keep copies of everything you submit for your records. If you have any questions, don’t hesitate to contact CareFirst BlueCross BlueShield for assistance.

Where should I send my completed claim form?

Your completed claim form, along with all attached bills and documentation, should be mailed to the address provided on the form. For the Maryland State Employees Health Claim form, send it to the administrator at P.O. Box 14115, Lexington, KY 40512-4115. Make sure to mail it promptly to avoid delays in receiving your benefits.