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Professional Claims and Referring Provider Documentation Requirements

Health Partners Plans (HPP) would like to remind billing staff that all billing requirements must be adhered to in order to ensure timely and accurate reimbursement. To be accepted as a valid claim, the submission must contain correct current coding, including, but not limited to, CPT, HCPCS, DRG, Revenue and ICD-10 codes and modifiers.

Providers who are registered as home health providers, hospice providers, certified nutritionists, DME, X-ray clinics and renal dialysis providers must include the referring provider on their claim submissions. The data can be submitted in the referring provider loop (2310A) or the ordering provider loop (2420E), whichever is appropriate to your claim situation.

This notice pertains to professional claims only.

In the event HPP identifies claim submissions that do not contain complete and correct coding, HPP may reject the claim, request additional information prior to payment or retrospectively audit applicable payments.

If you have any questions, please contact our Provider Services Helpline at 1-888-991-9023 (Monday – Friday, 9 a.m. – 5:30 p.m.).