Customer Claims Resolution Unit (CCRU) for Payor Claims Requiring Special Handling

The Customer Claims Resolution Unit (CCRU) is available for payors with claims that require special handling. The preferred method for submitting claims is via fax directly to the CCRU. The CCRU fax number is (314) 925-6632 .

A fax coversheet with claims are submitted to the CCRU. The coversheet should specify:

• Payor's name.
• Phone number and name of contact person (in case of questions).
• Return instructions (fax or mail and appropriate full phone numbers or addresses), especially if the claim reply is not to be mailed to the payor's standard mailing address.
• The specific nature of the problem or specific claim question.

The CCRU should not be used for:

• Provider claims sent in error directly to a payor. Generally, misdirected claims should be returned to the provider for resubmission to NCPPO and HealthLink.
• Repriced manual claims that may have been routed to the wrong payor (rare event). Such claims can be returned to NCPPO and HealthLink via express mail service to the NCPPO and HealthLink general address:

  NCPPO and HealthLink
  Claims Department
  1831 Chestnut Street
  St. Louis, MO 63103
  1-877-284-0101

Claims submitted to the CCRU are usually returned in about five business days. Please be aware that payor requests for follow-up on claims submitted to the CCRU cannot be honored until at least five business days have elapsed. This helps the CCRU area to process claims most efficiently. The standard turnaround time is between three and five business days.

For payors performing their own code review, select claims must be returned to the network for re-repricing with correct procedure or service codes. CCRU also handles these requests via the special payor fax service.

If a claim needs repricing for a newly eligible member, please indicate this on the fax cover sheet and supply the eligible member's subscriber information, group and network effective dates.

New claims to HealthLink with a date of service over 60 days may be submitted to CCRU. Please send claims with date of service less than 60 days through normal routing process.

National Capital Preferred Provider Organization, Inc. ("NCPPO") is a Maryland corporation. HealthLink®, Inc., is an Illinois corporation. Both are organizers of independently contracted provider networks, which are made available by contract to a variety of payors of health benefits, including insurers, third party administrators or employers. Neither has control nor right of control over the professional, medical judgment of contracted providers, nor are they liable for any acts or failures to act, by contracted providers. Neither is an insurance company and neither has liability for benefits under benefit plans offered or administered by payors. HealthLink® is a registered trademark of HealthLink, Inc. Both companies are subsidiaries of WellPoint, Inc.