MedStar Family Choice-DC follows the District of Columbia's regulations in order to determine whether a claim is clean.

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-DC's Claims Processing Center, if MedStar Family Choice-DC is secondary.

  • A Medicare remittance notice, if Medicare is primary and MedStar Family Choice-DC 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.

  • Provide an invoice for medication or other items per contract or when requested.

  • Admitting and physician notes for emergency services that may not meet the standards for an emergency service.

  • A 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.

Claims must be submitted on a CMS-1500 or UB04 form as appropriate. Claims must be submitted within 365 days from the date of service.

MedStar Family Choice claims can be submitted electronically (see Electronic Claims Submission page) or via the following address:

MedStar Family Choice DC
Claims Processing Center
PO Box 211702
Eagan, MN 55121
P: 800-261-3371

Information current as of: