Provider Manual
14 CLAIM SUBMISSION AND ADJUDICATION PROCEDURES
14.16 Claim Correspondence
Claim correspondence is different from a payment dispute. Correspondence is when the plan requires more information in order to finalize a claim. Typically, IntegraNet makes the request for this information through the EOP. The claim or part of the claim may, in fact, be denied, but it is only because more information is required to process the claim. Once the information is received, IntegraNet will use it to finalize the claim.
The following table provides examples the most common correspondence issues along with guidance on the most efficient ways to resolve them.
| Type of Issue | What Do I Need to Do? |
| Rejected Claim(s) | Use the Claims email [email protected] when your claim was submitted electronically but was never paid or was rejected. We're available to assist you with setup questions and help resolve submission issues or electronic claims rejections. |
| EOP Requests for Supporting Documentation (Sterilization/Hysterectomy/Abortion Consent Forms, itemized bills and invoices> | Submit a Claim Correspondence Form, a copy of your EOP and the supporting documentation to: Claims Correspondence 1813 W. Harvard Ave., Ste 204 Roseburg, OR 97471 |
| EOP Requests for Medical Records | Submit a Claim Correspondence Form, a copy of your EOP and the medical records to: Claims Correspondence 1813 W. Harvard Ave., Ste. 204 Roseburg, OR 97471 |
| Need to submit a Corrected Claim due to errors or changes on original submission | Submit a Claim Correspondence Form and your corrected claim to: Corrected Claim 1813 W. Harvard Ave., Ste. 204 Roseburg, OR 97471 Clearly identify the claim as corrected. We cannot accept claims with handwritten alterations to billing information. We will return claims that have been altered with an explanation of the reason for the return. Provided the claim was originally received timely, a corrected claim must be received within 365 days of the date of service. In cases where there was an adjustment to a primary insurance payment and it is necessary to submit a corrected claim to IntegraNet to adjust the other health insurance (OHI) payment information, the timely filing period starts with the date of the most recent OHI EOB. |
| Submission of coordination of benefits (COB)/third-party liability (TPL) information | Submit a Claim Correspondence Form, a copy of your EOP and the COB/TPL information to: Claims Correspondence 1813 W. Harvard Ave., Ste. 204 Roseburg, OR 97471 |