Northwood Claim Information

Northwood claims must be:

• Submitted electronically or on a CMS 1500 Claim Form.
• PAPER claims must be completed in entirety and include;
  • Northwood’s authorization number.
  • Physician’s written order including NPI number.
  • Attached EOB for secondary claims.
  • Manufacturer’s name, description, and product number documented in Box 19 of the CMS claim form for not otherwise classified (NOC) items.
• ELECTRONIC claims must be completed according to HIPAA 837 transaction requirements detailed on Northwood’s website www.northwoodinc.com .
  • Not otherwise classified (NOC) claims must be submitted hard copy.
  • Secondary claims must be submitted hard copy and include the EOB.

Claims submitted without the required information will be rejected and must be resubmitted within the filing limitation timeframe (see below).

CLAIMS FILING LIMITATIONS

• BCN Commercial and BCN Advantage claims must be submitted to Northwood within 6 months from the date of service.
• Medicare Supplemental and other secondary claims must be submitted with an attached EOB, within 180 days from the date the claim is paid by other carrier or plan.
• Stockings for Medicare Primary/BCN secondary Members do not require submission to Medicare for denial; however, providers must obtain prior authorization and bill Northwood within the 6 month filing limitation.
• Filing limitations apply to all claims, including claims previously submitted and returned for missing or incomplete documentation.
• Claims statusing must be submitted within 90 days from claim payment date.
• Submit paper claims with the required medical and other carrier payment documentation to the following address:

NORTHWOOD, INC.
P.O. BOX 510
WARREN, MICHIGAN 48090-0510

CLAIMS PAYMENT CYCLE

• Northwood will process Blue Care Network claims and remit payment for clean claims within 30 days of receipt.
• A clean claim consists of the following information:
  • Provider Name/Address/ID Number.
  • Member Name/Address/Telephone.
  • Contract Number.
  • Date of Birth.
  • Other Insurance Information (if any).
  • Diagnosis(es) (ICD-9-CM Code and Description).
  • Date of Service.
  • Referring Physician and NPI.
  • Level II HCPCS Code.
  • Manufacturer name, description and product number for NOC items.
  • Service Type (Purchase or Rental).
  • Quantity (Monthly for Supplies, testing times per day for diabetic supplies).
  • Duration of Need.
  • Modifier.
  • Provider Charge.
  • Other Payment.
• Claims payment shall be limited to Northwood’s allowable fee less any co-payment or primary payment amount.
• Northwood maintains the right to request proof of delivery or hard copy prescription upon request. Payment will be suspended pending requested documentation.
• Payment is contingent upon provider’s compliance with all applicable documentation requirements.