When submitting claims for services, drugs or procedures performed by physicians that do not have a specific CPT or HCPCS code, do not select a code that merely approximates the services provided. If no such procedure, drug or service codes exists, report the service using the appropriate unlisted procedure, drug or service code.
The following will help to expedite the processing of claims with unlisted codes.
- When submitting an unlisted code for drugs, include Name of Drug, NDC number and dosage given.
- When submitting an unlisted code for surgical procedures, include description of procedure and operative and pathology notes.
- When submitting an unlisted code for radiology service, include description and radiology report.
- When submitting an unlisted code for equipment or other services, include description.
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Find out who to contact for questions about participating with us, updating participation status or practice information, fee schedules, staff in-services, billing, contracting efforts, and more!
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Your health plan at your fingertips. PHP Go! allows you to make the most of your health plan in the palm of your hand.
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PHP accepts electronic claims from all clearinghouses, as well as HIPAA-compliant files from providers. Our payer ID number is 12399.*
If you have any questions or issues regarding electronic claim submission, please contact PHP Customer Service at (260) 432-6690, ext. 11; toll-free at 1-800-982-6257, ext. 11; or custsvc@phpni.com.
* Our payer ID number is also 12399 for electronic remittance advice (835).
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If you have a healthy group of 25 or more people in your company or organization, you should consider a self-funded plan. This means the employer is financially responsible for the healthcare…
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