Claim Submission Tips for Ambetter

Date: 12/13/22

As a reminder, Ambetter from Superior HealthPlan providers must complete certain requirements when submitting paper claims to ensure claims are not denied or rejected. Below are some commonly missed requirements:

• Professional providers and medical suppliers complete the CMS 1500 (02/12) Claim Form and institutional providers complete the CMS 1450 (UB-04) Claim Form. Specifics include:
  • Providers must use original red and white version of claim form.
  • Ambetter does not supply claim forms to providers. Providers should purchase these from a supplier of their choice.
• All paper claim forms must be typed with either 10- or 12-point Times New Roman font and on the required original red and white version to ensure clean acceptance and processing.
• To reduce document handling time, do not use highlights, italics, bold text, or staples for multiple page submissions.
• Black and white forms, handwritten forms and non-standard forms will be up front rejected and returned to provider

For more tips for successful submissions of paper claims, please review the Ambetter Provider Manual found on Ambetter Provider Resources webpage.

For questions related to claims submissions, please contact your local Ambetter Health Account Manager.