Claims Submission

Important Notice: As of October 1, 2017, the MedStar Family Choice contract to provide Medicaid services to residents in the District of Columbia has ended. Learn more >

Standard Required Attachments

The following describes circumstances under which the identified attachment is required for submission with the claim.

  • An explanation of benefits statement from a primary payer to MedStar Family Choice's Claims Processing Center, if MedStar Family Choice is secondary.
  • A Medicare remittance notice, if Medicare is primary and MedStar Family Choice is secondary.
  • A description of the procedure or service, which may include the medical record, if a procedure or service has no corresponding Current Procedural Terminology (CPT) or HCPCS code.
  • Information related to an audit, if a pattern of fraud, improper billing, or coding is demonstrated.
  • An itemization of charges is required, to include CPT/HCPCS codes, for outpatient hospital claims billed on a UB04 with the Revenue Code 250 series, on those claims that are greater that $500 billed charges.
  • An itemization is not required if the CPT/HCPCS codes are initially billed on the claim.
  • An itemization of charges may be required for inpatient hospital claims to correctly pay a bed day when other similar bed days are denied in that same inpatient admission.

Please share this information with your staff and/or billing agent as appropriate.

Information current as of: 08/30/19