CP 35 - Eligibility Determination


Basics

This short standard simply requires that your organization make a determination of whether the consumer was eligible for benefits on the date of service.

CP 34 - Claims Processing Criteria


Basics

This standard requires that your organization, when it is assessing whether a claim is "clean":

CP 33 - Claims Intake


Basics

This standard requires that your organization, for each claim it receives, record the date of receipt and assign a tracking number to the claim.

CP 32 - Claims Adjudication Process


Basics

This standard requires that your organization use consistent and uniform processes to adjudicate claims.

CP 31 - Clean Claims Criteria


Basics

This standard requires that your organization establish criteria that clearly define the requirements for a "clean claim." It may be that your organizaiton has a single definition fo

CP 30 - Payment Policy Disclosure


Basics

This standard requires that your organization have a process to provide specific payment rules and policies when requested to do so by a claimant or potential claimant.

CP 29 - Web Site Access


Basics

This standard requires that your organization have a Web site, and that the Web site provide the following:

CP 28 - Telephone Access


Basics

This standard lists 9 requirements for the telephone information service that your organization provides to claimants. Those requirements are:

CP 27 - Claims Communication


Basics

This standard requires that your organization's claim forms and/or other materials providing guidance on the submission of c

CP 26 - Claims Criteria


Basics

This standard requires that your organization's claim forms and associated materials quite clearly explain: