Claim Submission Requirements
This page includes guidance on Claims Submission Requirements. This information is compliant with California AB-1455 regulations. Claims can be sent to CHCN in either paper or electronic format.
Paper claims should be sent on CMS -1500 to:
Community Health Center Network
101 Callan Avenue, Suite 300
San Leandro, CA 94577
Attn: Claims Department
CHCN Claims Department
Paper Claims should be formatted in accordance with the following listed specifications.
CMS -1500 (version 02/12) – Professional Services
UB-04 – Facility Services should be billed to HMO
Attachments for paper claim submissions should accompany the mailing. Click here for a list of Commonly Required Claim Attachments.
Electronic Claims are electronically received via a secure file transfer protocol (SFTP) transmission. Electronic claims can be submitted in Health Insurance Portability and Accountability Act (HIPAA) compliant ANSI x12 5010x 837 Professional and Institutional claim formats. The standard 837 specifications can be downloaded from http://www.wpc-edi.com/hipaa/HIPAA_40.asp.
In addition to the Implementation Guides, there are additional requirements outlined in the CHCN Companion Guide. The details of the CHCN Companion Guide are available in PDF format here:
CHCN 837 Professional 005010X222A1 Companion Guide – PDF
There is a period of testing before production files are produced. CHCN does work with third party clearinghouses. CHCN EDI Department will coordinate the implementation process with your IT department or vendor.
CHCN EDI Department Contact: Mark Delgado
Telephone Number: 510-297-0298
Acknowledgement of Claims
Providers can log into our secure web-portal to view Claims acknowledgement. All paper claims are acknowledged within 15 working days. Electronically submitted claims are acknowledged by email within two (2) working days from receipt of the claim.
**HIPAA regulations require that patient identifiable health information be protected. Click here for a list of what is considered Protected Health Information.**