Billings & Claims
Claims Process & Payment
Soundpath Health uses the CMS standard of processing 95% of clean claims from non-contracted Providers within thirty (30) days of receipt and will pay interest on claims that do not meet this standard. 95% of unclean claims from non-contracted Providers will be paid in sixty (60) days. Reimbursement to non-contracted Providers will be the amount the Provider would have received under original Medicare.
A “clean claim” is an uncontested, complete, accurate, and valid claim, submitted on a CMS-1500 or UB-04, which has all mandatory entries and truthfully represents medically necessary services provided to a Soundpath Health member as documented in their medical record and which complies with standards established by Soundpath Health. It is also defined as a claim that has no defect or impropriety, including lack of required substantiating documentation for non-contracting Providers and suppliers, or particular circumstances requiring special treatment that prevents timely payment for being made on the claim. 95% of claims from contracted Providers will be paid in sixty (60) days or as required by the Participant Agreement.
Electronic Claims Submission
Soundpath Health uses Emdeon as the primary clearinghouse for claims. The clearinghouse’s use of specific system edits ensures the accuracy of all claims forwarded. If you are a physician, other health care professional or facility you may use electronic transactions.
Please use Emdeon Claims Submission payer ID #42172.
Paper Claims Submission
Claims need to be submitted on the appropriate claim form
(CMS-1500 for professional claims and the UB-04 for facility claims).
Please send claims to:
PO Box 853924
Richardson, TX 75085-3924
Soundpath Health claim form samples:
|Sample CMS-1500 form
|Sample UB-04 form
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