Asset 2

Claim Submission Requirements

This page includes guidance on Claims Submission Requirements. This information is compliant with California AB-1455 regulations. We strongly encourage electronic claims submission.

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
Phone: 510-297-0210
Fax: 510-297-0222
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.

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.**