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and be a part of our life-changing mission
to improve quality-of-life for patients statewide.

Claims Description of submission requirements

Gain access to a fast-growing, loyal patient base
and be a part of our life-changing mission
to improve quality-of-life for patients statewide.

Hamaspik Medicare

Summary of Services Requiring Prior Authorization

(consult Provider Manual for full list)

 

When requesting prior authorization, please specify ICD-10 Diagnosis Codes and proposed HCPCS/CPT service codes.

The following timeframe standards apply to all services requiring prior authorization:

  • Elective Services - 14 days prior to the scheduled elective service. If contact cannot be made 14 days prior to the scheduled service, it should be made as soon as medically possible prior to the scheduled service.
  • Urgent Services – Anytime prior to urgent services being rendered. If contact cannot be made prior to an urgent service, then contact must occur within one business day of the service.
  • Emergent Services - Notification within one business day of emergent services.

 

Contact Care Management to obtain prior authorization for the following service categories: (for a more detailed list of services that require prior authorization please see the Provider Manual.)

  • Diagnostic Tests Procedures -- Authorization is required for certain diagnostic procedures, non-lab tests and genetic testing procedures. Routine lab tests do not require prior authorization.
  • All Inpatient Admissions, including inpatient Mental Health Services
  • Skilled Nursing Facility
  • Physical, Occupational or Speech Therapy
  • Hearing Exam to diagnosis and treat hearing and balance issues
  • Dental Services
  • Cardiac, Rehabilitation, Pulmonary Rehabilitation and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services
  • Ambulance for non-emergencies
  • Medicare Part B drugs
  • Observation Stay
  • Organ Transplants and Transplant Evaluations
  • Reconstructive procedures that may be considered cosmetic
  • Selected DME
  • Oxygen
  • Wheelchairs/Power Wheelchairs
  • MRA & PET scans
  • Sleep Disorders
  • All Home Health Care
  • All Out of Network Referrals
  • Experimental/Investigational Services
  • Medical Nutritional Therapy
  • Radiation Therapy
  • Nuclear Medicine

Prior Authorization Request form

 

Hamaspik Claims Department

Tel. 1-833-HAMASPIK (1-833-426-2774) select “Provider” then option 2
Monday – Friday 9:00 a.m. to 5:00 p.m.

 

Mail Paper Claims to:
Hamaspik Managed Care
Attn: Claims
58 Route 59, Suite 1
Monsey, NY 10952
 
 
Electronic Submissions:
Change Healthcare (Clearinghouse)
Tel. 1-866-371-9066
Hamaspik payer ID #47738

 

 

General Requirements for Claims Submissions
  • Claims must be completed accurately and in full, in accordance with the instructions presented in Hamaspik’s provider manual. (See subsequent paragraphs). Hamaspik cannot pay claims that are inaccurate or incomplete.
  • Claims must be submitted on a CMS-1500 form or electronic equivalent (professional claims) or UB-04 or electronic equivalent (institutional claims).
  • Procedures must be identified by Current Procedural Terminology (CPT-4) or HCPCS codes. Diagnoses must be identified by ICD-10-CM diagnosis codes.
  • Place of service (POS) must be identified using the codes established by CMS. These codes apply to paper submittals of professional claims. Valid place of service codes for electronic submittals are included in providers’ implementation guides for HIPAA-compliant electronic transactions.
  • Procedures and diagnoses should be coded to the highest degree of specificity. For example, include 7th digit on ICD-10-CM codes when applicable.
  • Claims with referral or prior authorization requirements must include the authorization number.
  • Facility billers must include a revenue code to identify services rendered.
  • All required supporting material must be made available to Hamaspik upon request.
  • Claims submitted to all payors, must include an NPI to identify each provider for which data is reported on the claim. Hamaspik cannot accept any claims that do not include an NPI.
  • Taxonomy codes are required on all claim submissions. Claims submitted without taxonomy will be returned. Providers may have multiple taxonomy codes and should only include the taxonomy code that applies to the services performed and reported on the claim submission.
  • All claims must be submitted to Hamaspik Inc. within the timeframe specified in the provider agreement. Out of network providers must submit claims within 120 days from date of service.

By partnering with Hamaspik, providers enjoy countless advantages:

 
  • Access to members in the communities where you provide healthcare services
  • Eligibility and benefit information available
  • Electronic claims submission and claims processing in an efficient manner
  • Step-by-step billing instructions
  • Ongoing support from experienced Hamaspik staff

Provider Relations Department

 

Phone: 845-503-0907

Fax: 845-503-0911

Email : providerrelations@hamaspikchoice.org

 

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