Claims, Billing, and Payment

Claim Dispute Forms

• Carolina Complete Health Standard Plan: Claim Reconsideration and Grievance Form (PDF)
• Trillium Tailored Plan Physical Health: Claim Reconsideration and Grievance Form (PDF)
• Partners Tailored Plan Claim Grievance/Complaint Process

Billing Manual and Provider Guides

• Billing Manual (PDF)
• FQHC Billing Guidance
• Claims and Billing FAQ
• Electronic Submission Methods for CCH, Partners, and Trillium (PDF)
• Tailored Plan Billing with Partners and Trillium for Physical Health Providers (PDF)
• Provider Taxonomy Guide (PDF)
• Provider Guide: Claim Corrections, Reconsiderations, and Grievances (PDF)
• Claims Guide- Timely Filing (PDF)
• EPSDT Claims and Authorizations (PDF)
• Provider FAQ- Pended Claims Requiring Additional Information (PDF)
• Claims Guide- Duplicate Submissions (PDF)
• Pediatric Provider Billing Guidance (PDF)
• Claims Submission Reminder Guide (PDF)
• Provider Guide for 340B Drug Claims (PDF)
• Guidance for Submitting CLIA Claims (PDF)
• Coordination of Benefits Walkthrough (PDF)
• 835 EDI Companion Guide (PDF)
• 837 EDI Companion Guide (PDF)
• 2022 AMA Coding Guidelines for Social Determinants of Health (PDF)

Electronic Funds Transfer (EFT)

• Payspan is an innovative web-based solution for Electronic Funds Transfers (EFTs) and Electronic Remittance Advices (ERAs). By using Payspan, you can speed up the processing and payment of your claims. 
• Note: In November of 2022, Zelis, a company modernizing the business of healthcare, completed the acquisition of Payspan.  Providers should continue using the Payspan payment portal: login or register.
• Payspan: A Faster, Easier Way to Get Paid (PDF)
• To contact Payspan: Call 1-877-331-7154, Option 1 – Monday thru Friday 8:00 am to 8:00 pm est.

Provider Claims Schedule

Definitions

• Paid in Full - The claim has been adjudicated, processed and reimbursed in accordance and with the executed provider contract on file including the coordination of benefits, as applicable per claim.