q�2)�@����� �H2$`�v!A� �� ���#A��C�ن���;���0:$~;7�0?�瑐�R ��`�? I-electronic. Member Name: _____ Retro-Review claims Key Benefit Administrators is a new payer with Midlands Choice effective January 1, 2021. If you would like to receive electronic remittance, simply complete the brief Electronic Remittance Advice enrollment form. Retro-Review claims submitted with the Aetna ID will be rejected. A Direct To Provider Strategy. Box 3252, Milwaukee, WI 53201-3252. Milwaukee, WI 53201 Vision Claims. Direct Dental Corrected Claims. Providers receive an Explanation of Payment (EOP) including each claim submitted to iCare. iCare’s Timely Filing Limit is 120 days from the Thru date on a UB04 claim form unless otherwise specified in the Provider’s Contract. iCare has provided reason codes and narratives for the remittance advice in a convenient location below. Select iCare in the payer drop down box on the registration form to avoid paying any set-up or submission fees for your iCare claims through SSI Claimsnet. What's 53201-2900? 5-Group. Box 2907 Milwaukee, WI 53201-2907 Fax: 617-886-1199 Professional Relations Phone: 617-886-1009 Toll free: 800-451-1249 x61009 Fax: 617-886-1414 Monday – Friday, 8:30 a.m. to 4:30 p.m. EST E-mail: prteam@deltadentalma.com Provider Operations Phone: 617-886-1160 Toll free: 800-451-1249 x61160 Fax: 617-886-1414 benefit administrative systems (bas) po box 2920 milwaukee wi 53201 BENEFIT AND RISK MANAGEMENT SERVICES INC 80 IRON POINT CIRCLE FOLSOM CA 95763 (916)467-1400 BENEFIT ASSISTANCE CORPORATION PO BOX 790 RIPLEY WV 25271 (800)982-7838 National General Accident and Health P.O. Providers who do not have an NPI, please enter 9999999999 in the *required field. PO Box 497. Customer Service: 1-800-777-4376 | TTY: 1-800-947-3529 24 hours-a-day, 7 days-a-week iCare strives to process submitted claims in a timely and accurate manner. A Medicare EOB is not needed. PO Box 2906 . Reconsideration/Formal Appeal is a formal process to review a processed claim when the provider does not agree with the outcome and feels the claim warrants an adjustment. Below is detail information. h�b```f``z���� ��A��2�@q� 1 � �A�J�� Milwaukee, WI 53201. Because you need a professional medical billing services to help you manage your claims cycle effectively and save your staff time to assist you better towards quality patient care.. Service Highlights Guaranteed Reimbursement in 21 Days Offering services for 300+ Physicians RCM support for 150+ Medical Groups No long-term contracts Just one month prior notice to terminate the contract. If you need to file a claim with Assurant Health, contact the claims department at 1-877-284-4727. The forms providers should use are below. To register with SSI Claimsnet for electronic claims submission via the Internet, click here. Claims unable to be submitted electronically can be mailed to: Benefit Administrative Systems, LLC. Direct questions regarding the EOP to iCare's Provider Services: Professional LTC claims can be submitted via iCare’s professional services claim form by mail or use the Provider Portal, Residential LTC claims can only be submitted via iCare’s residential claim form by mail. BENEFIT ADMINISTRATIVE SYSTEMS LLC BAS02 36149 PO Box 2920, Milwaukee WI 53201 no site 800-523-0582 02/012019 EBMS-EE'S 10163 81037 PO Box 21367 Billings, MT 59104-1367 https://www.ebms.com/ 866.736.4749 02/012019 GMS TPA SERVICES GMS02 OBA16 PO Box 21933 Eagan, MN 55121 www.groupmgmt.com 440-527-2955 02/012019 If the member has both iCare Medicare and iCare Medicaid submit the original claim with the iCare Medicare identification number then both the iCare Medicare and iCare Medicaid claims process. This document was developed to assist you in understanding the EOP. PPO owned by Coventry. Dental Claims. Click anywhere to close. Schedule Demo. 1400 0 obj <>/Filter/FlateDecode/ID[]/Index[1380 74]/Info 1379 0 R/Length 106/Prev 110307/Root 1381 0 R/Size 1454/Type/XRef/W[1 3 1]>>stream 1380 0 obj <> endobj Resolves claims issues. Payer List. FirstHlth Nationwide Specialty insurance. In order to avoid processing delays, providers should complete the Review/Reopening form and attach any supporting documentation relevant to the request. Registration can be done online and you can immediately take advantage of on-line claims submission, real-time error reporting and payor updates. Save time and reduce costs as you increase office productivity and eliminate costly delays in reimbursement. Providers who do not have an NPI, please enter 9999999999 in the *required field. Request cannot be handled telephonically and should be mailed to iCare Appeal Department Address below within 60 days from the date of the EOP or response to the review/reopening request: Reconsideration/Formal Appeal Form Address: 1555 RiverCenter Drive, Suite 206 Market Launch - Segments. PO BOX 2906 Milwaukee, WI 53201-2906 Claims can be sent to EyeQuest Through our provider portal. iCare’s Timely Filing Limit is 120 days from the date of service (DOS) on a CMS 1500 claim form unless otherwise specified in the Provider’s Contract. Why? PO Box 2906 . Coordination of Benefits (COB) is necessary when a member is covered by more than one insurance carrier. PO Box 192. F-Comm Ins. ܯ�g�1���R��B��ٙgg���Ah.gBs�D��bJJ4�F�`��˜�:�y�H�,xKB`BI@AA�(Oj��0$���@L�nA���ܐ�ݨgR r/�:��4��I���~�Y��W*&C�+5S�G�@�Q�L A�cJu3�h%0���(δ�~����$!yZ�RN��0y���6FLYH�|`�v&��L{%���$ A� �EI2�)`� �f���Pi셈��Rg�1#5�E{HT��43��*�T�c� |h+�I�wΎ�}_�L/�^p��{!�l�Z��[�e�[�e�[�e�[�e�[��e-��|��vۃ�to�� >�7���Y?��~��Iӣ|ڞ���p��(ڋ�&��4�������y�2�N.�Z2��(/:�eY�;;=9�v. Please note: iCare charges a $25.00 fee for additional EOPs. h�bbd```b``v �3@$�Q�~�N �l{A$�"�"YX$Lr�HF� "ˏI���>0�H��������3�^�Q��?���g �Z� �� �v��m@Z���"����}��?�$�\�"�^�"�����w��4�� Review/Reopening requests can also be made telephonically by calling Customer Service or can be mailed to the address below within 60 days from the date of the EOP: NOTE: Any Medicaid claims related to a Family Care Partnership member may not utilize the review/reopening request. Provider can also obtain a copy of their EOP from the Provider Portal. The National CLAS Standards are intended to advance health equity, improve quality and help eliminate health care disparities by establishing a blueprint for individuals and health care organizations to follow. However, when claims processing and submission errors do occur, iCare's goal is to accurately resolve the situation as quickly as possible. 500. N018 . Payer Information. Please check our provider page for your state's provider portal. Payer Name Payer Number EDI Payer # Claim Submission Address Website Eligibility Verification Client Migrated ALLIED BENEFIT SYSTEMS INC 10004 37308 POBox 909786-60690 Chicago, IL 60690 www.alliedbenefit.com 800-288-2078 02/012019 BENEFIT ADMINISTRATIVE SYSTEMS LLC BAS02 36149 PO Box 2920, Milwaukee WI 53201 no site 800-523-0582 02/012019 Direct Dental Appeals. Electronic Claims should be sent: Direct entry on the web www.dentaquest.com Or, Via Clearinghouse Payer ID CX014 . Schedule Demo. Note: If the original iCare claim denies for the Primary EOB, the provider has to submit a paper corrected claim with the itemized Primary EOB within 60 days of the original iCare EOP date. P.O. Electronic claims submission is also available; please visit our website for options. PO Box 1334. Refer to the iCare Provider Reference Manual or the iCare FCP Provider Reference Manual for more information. Milwaukee, WI 53212. PO Box 1997, MS 6280 Milwaukee, WI 53201-1997 Toll-free: 1-800-482-8010 www.childrenscommunityhealthplan.org Covering you. 855-866-2615. providerservices@directdentalplans.com. How will providers be reimbursed? iCare is introducing a new process for Review/Reopening and Reconsideration/Formal Appeal process. Independent Care Health Plan has adopted all National Standards for Culturally and Linguistically Appropriate Services (CLAS). Hours: Mon – Fri, 8am – 5pm Pacific Time, closed on holidays. Box 2070 Milwaukee, WI 53201-2070 PO Box 2176 Milwaukee, WI 53201 EDI Payer ID: GP133 Online submission: uhc roviders.com UnitedHealthcare Dental PO Box 2053 Milwaukee, WI 53201 EDI Payer ID: GP133 Online submission: uhcproviders.com UnitedHealthcare Dental Provider Relations 6220 Old Dobbin Lane Columbia, MD 21045 UnitedHealthcare Dental Attn: Appeals Department PO Box 361 PO Box 2920. Questions regarding electronic claims submission: Milwaukee, WI 53201-2920 . 53201-2900 is a ZIP Code 5 Plus 4 number of PO BOX 2900 (From 2900 To 3299) , MILWAUKEE, WI, USA. If you're asking for reimbursement for a dental service that's covered by your plan, download and fill out this form: Dental Claim Reimbursement Form (PDF) Mail to: Blue Cross Blue Shield of Michigan. Claims appeals must be submitted within 90 business days from the date of denial. This new process will ensure that provider’s disputes are handled in a fast, fair and cost-effective manner. %%EOF Accelerated access to funds with direct deposit into your existing bank account, Reduced administrative costs by eliminating paper checks and remittances, No disruption to your current workflow — ERAs can also be routed to your existing clearinghouse. Life insurance and annuities are issued and employee benefit plans are insured by Symetra Life Insurance Company, 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004, and are not available in all U.S. states or any U.S. territory. SDCOM Claim Submission Mailing Addresses. Contracted providers wanting to modify their demographic information can request this by filling out the applicable form below: For tips on successful EFT enrollment, please see the check list. Note: Does not apply to LTC providers. •Highest Quality Care •Lowest Available Cost. Fax: 262.834.3589 . PO Box 420, Springfield, MA 01101/ 800-517-4791 . BANKERS CLAIM SER.… (Read more) PO Box 2920 Milwaukee, WI 53201-2920 . P.O. A representative of iCare will contact you. 36149. blank. 36149 Benefit Admin Systems (BAS) (PO Box 2920 Milwaukee, No 36149 Benefit Admin Systems (BAS)(Farmington Hill, MNI) No 36149 Benefit Admin Systems (BAS)(St. Louis, MO) No 36149 Benefit Admin Systems(BAS) (Homewood, IL) No 41205 Benefit Administration Services (Eagan, MN) No 25145 Benefit Coordinators Corporation (Pittsburgh, PA) No Corrected Claims can be submitted by using one of the following methods: *Members in the Family Care Partnership program are entitled to benefits beyond the benefits available to Medicare Advantage and Medicaid SSI members. •Keep healthcare dollars within the county •Drive down costs for employer’s health plan. Provider Services. Or through your clearinghouse - our Payer ID through Emdeon is 63740 Or by mai at: Attn: Vision Claims Processing PO BOX 433 Milwaukee, WI 53201-0433 Fax: 888-696-9552 Corporate Headquarters: P.O. Rising Medical Solutions specializes in medical bill review and medical cost containment for workers' compensation, auto, liability and group health payers. Outcome. We hope you enjoy our new look! endstream endobj 1381 0 obj <>/Metadata 22 0 R/Outlines 88 0 R/PageLayout/SinglePage/Pages 1378 0 R/StructTreeRoot 91 0 R/Type/Catalog>> endobj 1382 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 1383 0 obj <>stream Box 2907 Milwaukee, WI 53201-2907 Independent Care Health Plan (iCare) only provides these links and pointers for your information and convenience. A list of these LONG TERM CARE services can be found in the iCare Family Care Partnership section of this site. 506BB . Auxiant is looking for great people like you to help our customers.. We hire talented, motivated people, who work collaboratively to help our clients and partners solve real challenges every day. Direct Dental Claims. By clicking this link, you may be leaving the iCareHealthPlan.org website. Professional and Facility corrected claims can also be submitted electronically by following the 5010 standards for electronic claims submission – the provider’s clearinghouse will be aware of these requirements. Medical Clearance Form Please fax the completed form to (608) 467-4602 or email to support@kiio.com. Select iCare in the payer drop down box on the registration form to avoid paying any set-up or submission fees for your iCare claims through SSI Claimsnet. Payer ID Claim Office # Type Name Address City State Zip 98999 2691 X A.B.S. Demographic Change Form, Adding or removing providers associated with a contracted provider group PO Box 8400 London KY 40742. Claims may be submitted to Benefit Administrative Systems (BAS) electronically, with the Payer ID: 36149 . In order to process a claim when iCare is not the primary carrier, a complete Explanation of Benefits (EOB) from the primary insurer, including the Medicare EOB (MEOB), must accompany a copy of the original claim. Additional benefits include: You have two simple options to register for free ERA/EFT from InstaMed: Providers who do not have a National Provider Identifier (NPI) should submit the Order Form – Payer Payments. 1453 0 obj <>stream New day paper claims submitted with a Primary carrier explanation of benefits (EOB) will be processed as timely as long as the EOB has been submitted within 90 days of the Primary carrier’s EOB date. Affiliation Change Form. Claims may be submitted to Benefit Administrative Systems (BAS) electronically, with the Payer ID: 36149 . PO Box 2920 Milwaukee WI 53201. PO Box 22712 Long Beach, CA 90801: Provider Services: 855-322-4079: 120 Calendar Days from the DOS: Molina Healthcare of Ohio - Medicaid (Dental Claims) SKYGEN: PO Box 2136 Milwaukee, WI 53201: Provider Services: 855-322-4079: 180 Calendar Days from the DOS: Molina Healthcare of Puerto Rico - Medicaid: 81794: PO Box 364828 San Juan, PR 00936-4828: Provider Services: Milwaukee, WI 532 01- 2906 . With few exceptions, iCare Medicaid is the payer of last resort in most COB circumstances. Please submit questions to Helpdesk_Dallas@ssigroup.com or call 800-356-0092. iCare has joined the InstaMed Network to deliver your payments as free electronic remittance advice (ERA) and electronic funds transfer (EFT) in the near future. Milwaukee, WI 53201- 2906 . PO Box 0392 Milwaukee, WI 53201/or PO Box 52407 Cedar Rapids, IA 52407 06126 or 76079 www.auxiant.com BCBS-Wellmark (Blue Dental) 877-333-0164: PO Box 9354 Des Moines, IA 50306 CBIA1: www.wellmark.com BCBS of AL 888-783-5113 PO Box 2294 Birmingham, AL 35201-2294 CBAL1 https://www.bcbsal.org/providers/ BCBS of NM 888-349-3706 84100 www.bcbsnm.com �c;�S���™xp9O?��d�p��#+�@�Ƴ�� ��9\2�Ȓ)P"��a����1\3�Ț���Z�)M�ဴ�b�h�ESH�m��sT(����M3�l Quality is a top priority. Include address on electronic claims DentaQuest, LLC . Box 491 Milwaukee, WI 53201-0491 Fax paper claims for Medicare Advantage and Healthy Kids Dental to: 1-262-834-3589 Electronic claims: Payor ID is 382069753. Please work with your clearinghouse to submit claims electronically. These requests will need to be submitted as a corrected claim or a formal appeal. Milwaukee, WI 53201 Appeals. PO Box 2189 Milwaukee, WI 53201 800-261-3371 Processes claims and encounter data. Milwaukee, WI 53201 Corrected Claims. "�a H�������Do`�4�A�t�2��j�N�a#��Bb�x�ў(��U-�˥Y.e������b;7�p��#��*����'��!�S�,�Ҩ�5 iCare Remit Reason Codes. ��Dd�v;M�p�4#���*��. h޴XmO�H�+��թ����*$�J��7z���$n�ؑm FirstHlth-Coventry. 1112 ERA/EFT is a convenient, paperless and secure way to receive claims payments. iCare's EDI payer ID code is 11695. 506C. First Health Network-Coventry. Claims must be submitted within 180 days. BANKERS PO BOX 37511 OAK PARK MI 48237 98999 0248 X A.B.S. The provider must submit this request in writing. (LTC Providers should see LTC Claim Submission.). none. endstream endobj startxref • Electronic submission via clearinghouse, Payer ID: L0140 • Submit Retro-Review claims to: Aetna Better Health of Kansas: Claims PO Box 1607 Milwaukee WI 53201 All Retro-Review requests submitted should include the member’s Medicaid ID. Claims for patients who have coverage through Key Benefit Administrators should be submitted directly to the payer using Payer ID 37323 or the address P.O. Clinics (Regulated Space) Providers have 60 days from the original iCare explanation of payment (EOP) date to submit a corrected claim. Known Addresses for Direct Supply, Inc. 6767 N Industrial Rd Milwaukee, WI 53223 5621 Ottershaw Ct Brentwood, TN 37027 7505 Chestnut Hill Dr Prospect, KY 40059 6070 Peninsula Dr Nashotah, WI 53058 3 Riverhills Ln Toledo, OH 43623 Milwaukee, WI 53288 PO Box 88201 Milwaukee, WI 53288 N24W30803 Fairway Ct Pewaukee, WI 53072. Name, tax ID, physical or billing address changes Fax the form and supporting document/s to (877) 755-3392. Covering your kids. When you select a link to an outside website, you are leaving the www.iCareHealthPlan.org website. Sign up now to receive iCare payments as direct deposits! %PDF-1.5 %���� Copyright © 2021 Independent Care Health Plan, Electronic Funds Transfer (EFT) Enrollment, Electronic Remittance / 835 Transaction Enrollment, Review / Reopen or Reconsideration / Appeal Process, in the iCare Family Care Partnership section, 2017 iCare UB-04 Claim Requirement Document, 2015 iCare CMS 1500 Claim Requirement Document, 2019 iCare LTC Residential Services Claim Form, 2019 iCare LTC Professional Services Claim Form, in the iCare Family Care Partnership section, Electronic Remittance Advice enrollment form, Corrected claims must be marked as “corrected claim” and include, Paper claim submission with “Corrected Claim” stamped or written on the claim, CMS 1500 paper claim form with Box 22 indicating 7 (replacement of prior claim), UB04 paper claim form with last digit of bill type indicating 7 (117, 137, etc.). Benefit Administrative Systems Payer ID: 36149; Electronic Services Available (EDI) Professional/1500 Claims: YES: Institutional/UB Claims: YES: Electronic Remittance (ERA) YES: ERA Enrollment Required: Secondary Claims: YES: {b�~�H�. Value. Only claims that are complete will be accepted. Emdeon & DentalXChange Payer ID. Direct Dental Vision Claims. Review/Reopening is the first level request to review a processed claim when the provider does not agree with the outcome and feels the claim warrants an adjustment. payer id 95440 87726 N P O Box 6108 Lafayette IN 47903 ASRM CORP ASRM1 N ASSOCIATED ADMINISTRATORS AAIOR N PO BOX 1271 PORTLAND OR 97207 ASSOCIATES FOR HEALTHCARE 36326 N PO BOX 981 BROOKFIELD WI 53008 Assurant Employee Benefits - Formerly Fortis ASSUR N PO BOX 624 MILWAUKEE WI 53201 ASSURANT HEALTH - AETNA SIGNATURE ADMIN Nationwide Specialty Insurance. Concept. Mail paper claims to: Federal Employee Program Blue Cross Blue Shield of Michigan P.O. Providers should complete the Reconsideration/Formal Appeal form and attach supporting documentation, including the required Waiver of Liability (WOL) form. Dental claim form. How will providers be reimbursed? Providers are not required to first submit a review/reopening request, but are encouraged to do so for minimal processing errors. Coordination of benefits ( COB ) is necessary when a member is covered by more than one insurance.! Direct deposits original iCare explanation of payment ( EOP ) including each claim submitted to.! Would like to receive claims payments enrollment form hours: Monday - Friday 8:30 a.m. - p.m!, MA 01101/ 800-517-4791 explanation of payment ( EOP ) email to support @.. Insurance carrier when claims processing and submission errors do occur, iCare 's is. And convenience, with the Aetna ID will be rejected all National Standards Culturally..., click here click here does not have an NPI, please enter 9999999999 in the * required.! Provider does not have an NPI ” and attach a copy of your most recent of. Medical Solutions specializes po box 2920 milwaukee wi 53201 payer id medical bill review and medical cost containment for workers ' compensation, auto liability! Care Partnership Program are entitled to benefits beyond the benefits available to Medicare and... Review/Reopening request, but are encouraged to do so for minimal processing errors of the ’! Hours-A-Day, 7 days-a-week office hours: Monday - Friday 8:30 a.m. 5:00! Accurately resolve the situation as quickly as possible from the date of denial and for... Office hours: Mon – Fri, 8am – 5pm Pacific Time, closed on holidays are handled in timely!, Springfield, MA 01101/ 800-517-4791 you increase office productivity and eliminate costly delays reimbursement! New Payer with Midlands Choice effective January 1, 2021, when claims and! Most recent explanation of payment ( EOP ) need to file a claim with Assurant,. Blue Shield of Michigan P.O document/s to ( 877 ) 755-3392 iCare only! Program Blue Cross Blue Shield of Michigan P.O of liability ( WOL ) form with the ID. Office productivity and eliminate costly delays in reimbursement claim submission. ) Medicare Advantage and Medicaid SSI Members processing.... Milwaukee, WI 53201-1997 Toll-free: 1-800-482-8010 www.childrenscommunityhealthplan.org Covering you electronically, with the Aetna ID will rejected. Submit a corrected claim Appeal process: 1-800-947-3529 24 hours-a-day, 7 days-a-week hours. 0248 X A.B.S the * required field group Health payers 5pm Pacific Time, closed on holidays - 5:00.... Clinics ( Regulated Space ) PO Box 1997, MS 6280 Milwaukee WI! High-Value local healthcare providers through AdvantUs iCare Family Care Partnership Program are entitled to benefits beyond the benefits to. Strives to process submitted claims in a timely and accurate manner provider does have. Park MI 48237 98999 0248 X A.B.S po box 2920 milwaukee wi 53201 payer id days from the date of denial required field Accident. Outside website, you may be submitted electronically can be done online and you can immediately take Advantage on-line! Or email to support @ kiio.com outside website, you may be submitted 90. Assist you in understanding the EOP WI 53201-2070 Key Benefit Administrators is a Payer... On-Line claims submission Via the Internet, click here please check our provider page your. Necessary when a member is covered by more than one insurance carrier LTC providers should LTC! Original iCare explanation of payment ( EOP ) date to submit a corrected claim or a formal Appeal electronically with! Appeal form and attach any supporting documentation, including the required Waiver of liability ( WOL ).. Be rejected or, Via clearinghouse Payer ID CX014 Plan ( iCare only... Submitted as a corrected claim or a formal Appeal not required to submit. Claim submitted to iCare 1-800-777-4376 | TTY: 1-800-947-3529 24 hours-a-day, 7 days-a-week hours! Benefit Administrative Systems ( BAS ) electronically, with the Payer ID:.. Convenient location below ( WOL ) form also obtain a copy of their from... A new process will ensure that provider ’ s disputes are handled a. The provider portal nation ’ s disputes are handled in a timely and accurate manner unable! Documentation, including the required Waiver of liability ( WOL ) form to assist you in the... Systems, LLC when a member is covered by more than one insurance.... Clinics ( Regulated Space ) PO Box 1997, MS 6280 Milwaukee, WI 53201 800-261-3371 claims... Monday - Friday 8:30 a.m. - 5:00 p.m to submit claims electronically and any... With Midlands Choice effective January 1, 2021, simply complete the brief electronic Advice. To first submit a Review/Reopening request, but are encouraged to do so for minimal processing errors resolve situation... Encounter data, contact the claims department at 1-877-284-4727 requests will need file! Receive electronic remittance Advice in a convenient, paperless and secure way to receive electronic remittance simply... Independent Care Health Plan ( iCare ) only provides these links and pointers for your information convenience... Supporting document/s to ( 877 ) 755-3392 if you would like to iCare! Are leaving the iCareHealthPlan.org website who do not have an NPI, please enter 9999999999 the... Clearinghouse, SSI Claimsnet, to allow electronic claims submission Via the Internet, click.! 60 days from the provider portal Payer of last resort in most COB circumstances, iCare Medicaid the... To ( 877 ) 755-3392 submit a Review/Reopening request, but are encouraged to do so for processing! Be found in the iCare FCP provider Reference Manual for more information medical Solutions specializes in bill. Can be found in the Family Care Partnership section of this site links and for. Charges a $ 25.00 fee for additional EOPs have 60 days from the original iCare explanation of payment EOP... Npi ” and attach a copy of their EOP from the provider portal •direct contract with high-value local providers! Clicking this link, you may be submitted to Benefit Administrative Systems, LLC s claims. Also obtain a copy of your most recent explanation of payment ( EOP ) date submit... Claims in a fast, fair and cost-effective manner a.m. - 5:00 p.m is... Of on-line claims submission Via the Internet, click here WOL ) form ID will be rejected you like! Are encouraged to do so for minimal processing errors employer ’ s Health.. To first submit a Review/Reopening request, but are encouraged to do for., providers should complete the brief electronic remittance, simply complete the brief electronic remittance in... * Members in the Family Care Partnership section of this site pointers for your information convenience...: 36149 to benefits beyond the benefits available to Medicare Advantage and Medicaid SSI.! Your information and convenience “ provider does not have an NPI ” and attach any supporting documentation including! A Review/Reopening request, but are encouraged to do so for minimal processing errors Employee po box 2920 milwaukee wi 53201 payer id... Within the county •Drive down costs for employer ’ s disputes are handled in a and! The * required field SSI Claimsnet, to allow electronic claims submission. ) contact! Handled in a fast, fair and cost-effective manner Time and reduce costs you! Box 1997, MS 6280 Milwaukee, WI 53201 800-261-3371 Processes claims and encounter.... Date to submit a Review/Reopening request, but are encouraged to do so for minimal processing errors ' compensation auto... In medical bill review and medical cost containment for workers ' compensation, auto, liability and group Health.. Codes and narratives for the remittance Advice in a timely and accurate manner required field any! To support @ kiio.com Name: _____ National General Accident and Health P.O 8:30. Submit a corrected claim medical cost containment for workers ' compensation,,... Beyond the benefits available to Medicare Advantage and Medicaid SSI Members claims electronically attach supporting. Id will be rejected claims and encounter data: iCare charges a $ 25.00 fee for additional.. Please see the check list web www.dentaquest.com or, Via clearinghouse Payer ID: 36149 ( iCare ) only these... Processing and submission errors do occur, iCare 's goal is to resolve. Blue Shield of Michigan P.O the original iCare explanation of payment ( EOP ) including each claim to! Cob circumstances claim submission. ) the EOP narratives for the remittance Advice in a timely and accurate.. A member is covered by more than one insurance carrier write “ provider does have... Retro-Review claims submitted with the Payer of last resort in most COB.... Page for your state 's provider portal the date of denial delays in reimbursement submission. ) workers compensation! Insurance carrier Midlands Choice effective January 1, 2021 you increase office productivity and eliminate costly delays in.. All National Standards for Culturally and Linguistically Appropriate services ( CLAS ) of liability ( WOL ) form to... Icare provider Reference Manual or the iCare provider Reference Manual for more information understanding the.... And cost-effective manner Key Benefit Administrators is a convenient, paperless and secure way receive... Submission is also available ; please visit our website for options Choice effective 1. Medicare Advantage and Medicaid SSI Members request, but are encouraged to do so for minimal processing.!: 1-800-482-8010 www.childrenscommunityhealthplan.org Covering you Aetna ID will be rejected bankers PO Box 420, Springfield, MA 800-517-4791... Workers ' compensation, auto, liability and group Health payers Milwaukee, WI 53201-1997 Toll-free: 1-800-482-8010 Covering! 37511 OAK PARK MI 48237 98999 0248 X A.B.S closed on holidays ID CX014 compensation, auto, and. In understanding the EOP po box 2920 milwaukee wi 53201 payer id the iCare Family Care Partnership section of this.. ( 877 ) 755-3392 an NPI, please enter 9999999999 in the Family Care Partnership Program are to..., liability and group Health payers for tips on successful EFT enrollment, please enter in. " /> Top

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Funds are deposited directly into your designated bank account and include the TRN Reassociation Trace Number in accordance with CAQH CORE Phase III Operating Rules for HIPAA standard transactions. PO Box 9695 Boston, MA 02114 Claims Phone: 888-433-3582 Fax: 617-886-1600 Delta Dental of MA Attn: Liberty Mutual Unit P.O. 0 *Members in the Family Care Partnership program are entitled to benefits beyond the benefits available to Medicare Advantage and Medicaid SSI members. Office Hours: Monday - Friday  8:30 a.m. - 5:00 p.m. Claims unable to be submitted electronically can be mailed to: Benefit Administrative Systems, LLC. Box 312599 Attn: FEP Dept. A list of these LONG TERM CARE services can be found in the iCare Family Care Partnership section of this site. 9À�@��9�Wi^7& ���:�HK00�yQ��` �L � Select Benefit Administrators of Payer ID: 37282; Electronic Services Available (EDI) Professional/1500 Claims: YES: Institutional/UB Claims: YES: Secondary Claims: YES: This insurance is also known as: Select Benefit Administrators of America Write “Provider does NOT have an NPI” and attach a copy of your most recent explanation of payment (EOP). Box 491. . Filing the Claim With Assurant Health Insurance Provider. •Direct contract with high-value local healthcare providers through AdvantUs. iCare's EDI payer ID code is 11695. Payer Information. iCare is pleased to partner with one of the nation’s leading claims clearinghouse, SSI Claimsnet, to allow electronic claims submission. �������� �1���O,"��6.Qr��G�P>q�2)�@����� �H2$`�v!A� �� ���#A��C�ن���;���0:$~;7�0?�瑐�R ��`�? I-electronic. Member Name: _____ Retro-Review claims Key Benefit Administrators is a new payer with Midlands Choice effective January 1, 2021. If you would like to receive electronic remittance, simply complete the brief Electronic Remittance Advice enrollment form. Retro-Review claims submitted with the Aetna ID will be rejected. A Direct To Provider Strategy. Box 3252, Milwaukee, WI 53201-3252. Milwaukee, WI 53201 Vision Claims. Direct Dental Corrected Claims. Providers receive an Explanation of Payment (EOP) including each claim submitted to iCare. iCare’s Timely Filing Limit is 120 days from the Thru date on a UB04 claim form unless otherwise specified in the Provider’s Contract. iCare has provided reason codes and narratives for the remittance advice in a convenient location below. Select iCare in the payer drop down box on the registration form to avoid paying any set-up or submission fees for your iCare claims through SSI Claimsnet. What's 53201-2900? 5-Group. Box 2907 Milwaukee, WI 53201-2907 Fax: 617-886-1199 Professional Relations Phone: 617-886-1009 Toll free: 800-451-1249 x61009 Fax: 617-886-1414 Monday – Friday, 8:30 a.m. to 4:30 p.m. EST E-mail: prteam@deltadentalma.com Provider Operations Phone: 617-886-1160 Toll free: 800-451-1249 x61160 Fax: 617-886-1414 benefit administrative systems (bas) po box 2920 milwaukee wi 53201 BENEFIT AND RISK MANAGEMENT SERVICES INC 80 IRON POINT CIRCLE FOLSOM CA 95763 (916)467-1400 BENEFIT ASSISTANCE CORPORATION PO BOX 790 RIPLEY WV 25271 (800)982-7838 National General Accident and Health P.O. Providers who do not have an NPI, please enter 9999999999 in the *required field. PO Box 497. Customer Service: 1-800-777-4376 | TTY: 1-800-947-3529 24 hours-a-day, 7 days-a-week iCare strives to process submitted claims in a timely and accurate manner. A Medicare EOB is not needed. PO Box 2906 . Reconsideration/Formal Appeal is a formal process to review a processed claim when the provider does not agree with the outcome and feels the claim warrants an adjustment. Below is detail information. h�b```f``z���� ��A��2�@q� 1 � �A�J�� Milwaukee, WI 53201. Because you need a professional medical billing services to help you manage your claims cycle effectively and save your staff time to assist you better towards quality patient care.. Service Highlights Guaranteed Reimbursement in 21 Days Offering services for 300+ Physicians RCM support for 150+ Medical Groups No long-term contracts Just one month prior notice to terminate the contract. If you need to file a claim with Assurant Health, contact the claims department at 1-877-284-4727. The forms providers should use are below. To register with SSI Claimsnet for electronic claims submission via the Internet, click here. Claims unable to be submitted electronically can be mailed to: Benefit Administrative Systems, LLC. Direct questions regarding the EOP to iCare's Provider Services: Professional LTC claims can be submitted via iCare’s professional services claim form by mail or use the Provider Portal, Residential LTC claims can only be submitted via iCare’s residential claim form by mail. BENEFIT ADMINISTRATIVE SYSTEMS LLC BAS02 36149 PO Box 2920, Milwaukee WI 53201 no site 800-523-0582 02/012019 EBMS-EE'S 10163 81037 PO Box 21367 Billings, MT 59104-1367 https://www.ebms.com/ 866.736.4749 02/012019 GMS TPA SERVICES GMS02 OBA16 PO Box 21933 Eagan, MN 55121 www.groupmgmt.com 440-527-2955 02/012019 If the member has both iCare Medicare and iCare Medicaid submit the original claim with the iCare Medicare identification number then both the iCare Medicare and iCare Medicaid claims process. This document was developed to assist you in understanding the EOP. PPO owned by Coventry. Dental Claims. Click anywhere to close. Schedule Demo. 1400 0 obj <>/Filter/FlateDecode/ID[]/Index[1380 74]/Info 1379 0 R/Length 106/Prev 110307/Root 1381 0 R/Size 1454/Type/XRef/W[1 3 1]>>stream 1380 0 obj <> endobj Resolves claims issues. Payer List. FirstHlth Nationwide Specialty insurance. In order to avoid processing delays, providers should complete the Review/Reopening form and attach any supporting documentation relevant to the request. Registration can be done online and you can immediately take advantage of on-line claims submission, real-time error reporting and payor updates. Save time and reduce costs as you increase office productivity and eliminate costly delays in reimbursement. Providers who do not have an NPI, please enter 9999999999 in the *required field. Request cannot be handled telephonically and should be mailed to iCare Appeal Department Address below within 60 days from the date of the EOP or response to the review/reopening request: Reconsideration/Formal Appeal Form Address: 1555 RiverCenter Drive, Suite 206 Market Launch - Segments. PO BOX 2906 Milwaukee, WI 53201-2906 Claims can be sent to EyeQuest Through our provider portal. iCare’s Timely Filing Limit is 120 days from the date of service (DOS) on a CMS 1500 claim form unless otherwise specified in the Provider’s Contract. Why? PO Box 2906 . Coordination of Benefits (COB) is necessary when a member is covered by more than one insurance carrier. PO Box 192. F-Comm Ins. ܯ�g�1���R��B��ٙgg���Ah.gBs�D��bJJ4�F�`��˜�:�y�H�,xKB`BI@AA�(Oj��0$���@L�nA���ܐ�ݨgR r/�:��4��I���~�Y��W*&C�+5S�G�@�Q�L A�cJu3�h%0���(δ�~����$!yZ�RN��0y���6FLYH�|`�v&��L{%���$ A� �EI2�)`� �f���Pi셈��Rg�1#5�E{HT��43��*�T�c� |h+�I�wΎ�}_�L/�^p��{!�l�Z��[�e�[�e�[�e�[�e�[��e-��|��vۃ�to�� >�7���Y?��~��Iӣ|ڞ���p��(ڋ�&��4�������y�2�N.�Z2��(/:�eY�;;=9�v. Please note: iCare charges a $25.00 fee for additional EOPs. h�bbd```b``v �3@$�Q�~�N �l{A$�"�"YX$Lr�HF� "ˏI���>0�H��������3�^�Q��?���g �Z� �� �v��m@Z���"����}��?�$�\�"�^�"�����w��4�� Review/Reopening requests can also be made telephonically by calling Customer Service or can be mailed to the address below within 60 days from the date of the EOP: NOTE: Any Medicaid claims related to a Family Care Partnership member may not utilize the review/reopening request. Provider can also obtain a copy of their EOP from the Provider Portal. The National CLAS Standards are intended to advance health equity, improve quality and help eliminate health care disparities by establishing a blueprint for individuals and health care organizations to follow. However, when claims processing and submission errors do occur, iCare's goal is to accurately resolve the situation as quickly as possible. 500. N018 . Payer Information. Please check our provider page for your state's provider portal. Payer Name Payer Number EDI Payer # Claim Submission Address Website Eligibility Verification Client Migrated ALLIED BENEFIT SYSTEMS INC 10004 37308 POBox 909786-60690 Chicago, IL 60690 www.alliedbenefit.com 800-288-2078 02/012019 BENEFIT ADMINISTRATIVE SYSTEMS LLC BAS02 36149 PO Box 2920, Milwaukee WI 53201 no site 800-523-0582 02/012019 Direct Dental Appeals. Electronic Claims should be sent: Direct entry on the web www.dentaquest.com Or, Via Clearinghouse Payer ID CX014 . Schedule Demo. Note: If the original iCare claim denies for the Primary EOB, the provider has to submit a paper corrected claim with the itemized Primary EOB within 60 days of the original iCare EOP date. P.O. Electronic claims submission is also available; please visit our website for options. PO Box 1334. Refer to the iCare Provider Reference Manual or the iCare FCP Provider Reference Manual for more information. Milwaukee, WI 53212. PO Box 1997, MS 6280 Milwaukee, WI 53201-1997 Toll-free: 1-800-482-8010 www.childrenscommunityhealthplan.org Covering you. 855-866-2615. providerservices@directdentalplans.com. How will providers be reimbursed? iCare is introducing a new process for Review/Reopening and Reconsideration/Formal Appeal process. Independent Care Health Plan has adopted all National Standards for Culturally and Linguistically Appropriate Services (CLAS). Hours: Mon – Fri, 8am – 5pm Pacific Time, closed on holidays. Box 2070 Milwaukee, WI 53201-2070 PO Box 2176 Milwaukee, WI 53201 EDI Payer ID: GP133 Online submission: uhc roviders.com UnitedHealthcare Dental PO Box 2053 Milwaukee, WI 53201 EDI Payer ID: GP133 Online submission: uhcproviders.com UnitedHealthcare Dental Provider Relations 6220 Old Dobbin Lane Columbia, MD 21045 UnitedHealthcare Dental Attn: Appeals Department PO Box 361 PO Box 2920. Questions regarding electronic claims submission: Milwaukee, WI 53201-2920 . 53201-2900 is a ZIP Code 5 Plus 4 number of PO BOX 2900 (From 2900 To 3299) , MILWAUKEE, WI, USA. If you're asking for reimbursement for a dental service that's covered by your plan, download and fill out this form: Dental Claim Reimbursement Form (PDF) Mail to: Blue Cross Blue Shield of Michigan. Claims appeals must be submitted within 90 business days from the date of denial. This new process will ensure that provider’s disputes are handled in a fast, fair and cost-effective manner. %%EOF Accelerated access to funds with direct deposit into your existing bank account, Reduced administrative costs by eliminating paper checks and remittances, No disruption to your current workflow — ERAs can also be routed to your existing clearinghouse. Life insurance and annuities are issued and employee benefit plans are insured by Symetra Life Insurance Company, 777 108th Avenue NE, Suite 1200, Bellevue, WA 98004, and are not available in all U.S. states or any U.S. territory. SDCOM Claim Submission Mailing Addresses. Contracted providers wanting to modify their demographic information can request this by filling out the applicable form below: For tips on successful EFT enrollment, please see the check list. Note: Does not apply to LTC providers. •Highest Quality Care •Lowest Available Cost. Fax: 262.834.3589 . PO Box 420, Springfield, MA 01101/ 800-517-4791 . BANKERS CLAIM SER.… (Read more) PO Box 2920 Milwaukee, WI 53201-2920 . P.O. A representative of iCare will contact you. 36149. blank. 36149 Benefit Admin Systems (BAS) (PO Box 2920 Milwaukee, No 36149 Benefit Admin Systems (BAS)(Farmington Hill, MNI) No 36149 Benefit Admin Systems (BAS)(St. Louis, MO) No 36149 Benefit Admin Systems(BAS) (Homewood, IL) No 41205 Benefit Administration Services (Eagan, MN) No 25145 Benefit Coordinators Corporation (Pittsburgh, PA) No Corrected Claims can be submitted by using one of the following methods: *Members in the Family Care Partnership program are entitled to benefits beyond the benefits available to Medicare Advantage and Medicaid SSI members. •Keep healthcare dollars within the county •Drive down costs for employer’s health plan. Provider Services. Or through your clearinghouse - our Payer ID through Emdeon is 63740 Or by mai at: Attn: Vision Claims Processing PO BOX 433 Milwaukee, WI 53201-0433 Fax: 888-696-9552 Corporate Headquarters: P.O. Rising Medical Solutions specializes in medical bill review and medical cost containment for workers' compensation, auto, liability and group health payers. Outcome. We hope you enjoy our new look! endstream endobj 1381 0 obj <>/Metadata 22 0 R/Outlines 88 0 R/PageLayout/SinglePage/Pages 1378 0 R/StructTreeRoot 91 0 R/Type/Catalog>> endobj 1382 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC]/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 1383 0 obj <>stream Box 2907 Milwaukee, WI 53201-2907 Independent Care Health Plan (iCare) only provides these links and pointers for your information and convenience. A list of these LONG TERM CARE services can be found in the iCare Family Care Partnership section of this site. 506BB . Auxiant is looking for great people like you to help our customers.. We hire talented, motivated people, who work collaboratively to help our clients and partners solve real challenges every day. Direct Dental Claims. By clicking this link, you may be leaving the iCareHealthPlan.org website. Professional and Facility corrected claims can also be submitted electronically by following the 5010 standards for electronic claims submission – the provider’s clearinghouse will be aware of these requirements. Medical Clearance Form Please fax the completed form to (608) 467-4602 or email to support@kiio.com. Select iCare in the payer drop down box on the registration form to avoid paying any set-up or submission fees for your iCare claims through SSI Claimsnet. Payer ID Claim Office # Type Name Address City State Zip 98999 2691 X A.B.S. Demographic Change Form, Adding or removing providers associated with a contracted provider group PO Box 8400 London KY 40742. Claims may be submitted to Benefit Administrative Systems (BAS) electronically, with the Payer ID: 36149 . In order to process a claim when iCare is not the primary carrier, a complete Explanation of Benefits (EOB) from the primary insurer, including the Medicare EOB (MEOB), must accompany a copy of the original claim. Additional benefits include: You have two simple options to register for free ERA/EFT from InstaMed: Providers who do not have a National Provider Identifier (NPI) should submit the Order Form – Payer Payments. 1453 0 obj <>stream New day paper claims submitted with a Primary carrier explanation of benefits (EOB) will be processed as timely as long as the EOB has been submitted within 90 days of the Primary carrier’s EOB date. Affiliation Change Form. Claims may be submitted to Benefit Administrative Systems (BAS) electronically, with the Payer ID: 36149 . PO Box 2920 Milwaukee WI 53201. PO Box 22712 Long Beach, CA 90801: Provider Services: 855-322-4079: 120 Calendar Days from the DOS: Molina Healthcare of Ohio - Medicaid (Dental Claims) SKYGEN: PO Box 2136 Milwaukee, WI 53201: Provider Services: 855-322-4079: 180 Calendar Days from the DOS: Molina Healthcare of Puerto Rico - Medicaid: 81794: PO Box 364828 San Juan, PR 00936-4828: Provider Services: Milwaukee, WI 532 01- 2906 . With few exceptions, iCare Medicaid is the payer of last resort in most COB circumstances. Please submit questions to Helpdesk_Dallas@ssigroup.com or call 800-356-0092. iCare has joined the InstaMed Network to deliver your payments as free electronic remittance advice (ERA) and electronic funds transfer (EFT) in the near future. Milwaukee, WI 53201- 2906 . PO Box 0392 Milwaukee, WI 53201/or PO Box 52407 Cedar Rapids, IA 52407 06126 or 76079 www.auxiant.com BCBS-Wellmark (Blue Dental) 877-333-0164: PO Box 9354 Des Moines, IA 50306 CBIA1: www.wellmark.com BCBS of AL 888-783-5113 PO Box 2294 Birmingham, AL 35201-2294 CBAL1 https://www.bcbsal.org/providers/ BCBS of NM 888-349-3706 84100 www.bcbsnm.com �c;�S���™xp9O?��d�p��#+�@�Ƴ�� ��9\2�Ȓ)P"��a����1\3�Ț���Z�)M�ဴ�b�h�ESH�m��sT(����M3�l Quality is a top priority. Include address on electronic claims DentaQuest, LLC . Box 491 Milwaukee, WI 53201-0491 Fax paper claims for Medicare Advantage and Healthy Kids Dental to: 1-262-834-3589 Electronic claims: Payor ID is 382069753. Please work with your clearinghouse to submit claims electronically. These requests will need to be submitted as a corrected claim or a formal appeal. Milwaukee, WI 53201 Appeals. PO Box 2189 Milwaukee, WI 53201 800-261-3371 Processes claims and encounter data. Milwaukee, WI 53201 Corrected Claims. "�a H�������Do`�4�A�t�2��j�N�a#��Bb�x�ў(��U-�˥Y.e������b;7�p��#��*����'��!�S�,�Ҩ�5 iCare Remit Reason Codes. ��Dd�v;M�p�4#���*��. h޴XmO�H�+��թ����*$�J��7z���$n�ؑm FirstHlth-Coventry. 1112 ERA/EFT is a convenient, paperless and secure way to receive claims payments. iCare's EDI payer ID code is 11695. 506C. First Health Network-Coventry. Claims must be submitted within 180 days. BANKERS PO BOX 37511 OAK PARK MI 48237 98999 0248 X A.B.S. The provider must submit this request in writing. (LTC Providers should see LTC Claim Submission.). none. endstream endobj startxref • Electronic submission via clearinghouse, Payer ID: L0140 • Submit Retro-Review claims to: Aetna Better Health of Kansas: Claims PO Box 1607 Milwaukee WI 53201 All Retro-Review requests submitted should include the member’s Medicaid ID. Claims for patients who have coverage through Key Benefit Administrators should be submitted directly to the payer using Payer ID 37323 or the address P.O. Clinics (Regulated Space) Providers have 60 days from the original iCare explanation of payment (EOP) date to submit a corrected claim. Known Addresses for Direct Supply, Inc. 6767 N Industrial Rd Milwaukee, WI 53223 5621 Ottershaw Ct Brentwood, TN 37027 7505 Chestnut Hill Dr Prospect, KY 40059 6070 Peninsula Dr Nashotah, WI 53058 3 Riverhills Ln Toledo, OH 43623 Milwaukee, WI 53288 PO Box 88201 Milwaukee, WI 53288 N24W30803 Fairway Ct Pewaukee, WI 53072. Name, tax ID, physical or billing address changes Fax the form and supporting document/s to (877) 755-3392. Covering your kids. When you select a link to an outside website, you are leaving the www.iCareHealthPlan.org website. Sign up now to receive iCare payments as direct deposits! %PDF-1.5 %���� Copyright © 2021 Independent Care Health Plan, Electronic Funds Transfer (EFT) Enrollment, Electronic Remittance / 835 Transaction Enrollment, Review / Reopen or Reconsideration / Appeal Process, in the iCare Family Care Partnership section, 2017 iCare UB-04 Claim Requirement Document, 2015 iCare CMS 1500 Claim Requirement Document, 2019 iCare LTC Residential Services Claim Form, 2019 iCare LTC Professional Services Claim Form, in the iCare Family Care Partnership section, Electronic Remittance Advice enrollment form, Corrected claims must be marked as “corrected claim” and include, Paper claim submission with “Corrected Claim” stamped or written on the claim, CMS 1500 paper claim form with Box 22 indicating 7 (replacement of prior claim), UB04 paper claim form with last digit of bill type indicating 7 (117, 137, etc.). Benefit Administrative Systems Payer ID: 36149; Electronic Services Available (EDI) Professional/1500 Claims: YES: Institutional/UB Claims: YES: Electronic Remittance (ERA) YES: ERA Enrollment Required: Secondary Claims: YES: {b�~�H�. Value. Only claims that are complete will be accepted. Emdeon & DentalXChange Payer ID. Direct Dental Vision Claims. Review/Reopening is the first level request to review a processed claim when the provider does not agree with the outcome and feels the claim warrants an adjustment. payer id 95440 87726 N P O Box 6108 Lafayette IN 47903 ASRM CORP ASRM1 N ASSOCIATED ADMINISTRATORS AAIOR N PO BOX 1271 PORTLAND OR 97207 ASSOCIATES FOR HEALTHCARE 36326 N PO BOX 981 BROOKFIELD WI 53008 Assurant Employee Benefits - Formerly Fortis ASSUR N PO BOX 624 MILWAUKEE WI 53201 ASSURANT HEALTH - AETNA SIGNATURE ADMIN Nationwide Specialty Insurance. Concept. Mail paper claims to: Federal Employee Program Blue Cross Blue Shield of Michigan P.O. Providers should complete the Reconsideration/Formal Appeal form and attach supporting documentation, including the required Waiver of Liability (WOL) form. Dental claim form. How will providers be reimbursed? Providers are not required to first submit a review/reopening request, but are encouraged to do so for minimal processing errors. Coordination of benefits ( COB ) is necessary when a member is covered by more than one insurance.! Direct deposits original iCare explanation of payment ( EOP ) including each claim submitted to.! Would like to receive claims payments enrollment form hours: Monday - Friday 8:30 a.m. - p.m!, MA 01101/ 800-517-4791 explanation of payment ( EOP ) email to support @.. Insurance carrier when claims processing and submission errors do occur, iCare 's is. And convenience, with the Aetna ID will be rejected all National Standards Culturally..., click here click here does not have an NPI, please enter 9999999999 in the * required.! Provider does not have an NPI ” and attach a copy of your most recent of. Medical Solutions specializes po box 2920 milwaukee wi 53201 payer id medical bill review and medical cost containment for workers ' compensation, auto liability! Care Partnership Program are entitled to benefits beyond the benefits available to Medicare and... Review/Reopening request, but are encouraged to do so for minimal processing errors of the ’! Hours-A-Day, 7 days-a-week office hours: Monday - Friday 8:30 a.m. 5:00! Accurately resolve the situation as quickly as possible from the date of denial and for... Office hours: Mon – Fri, 8am – 5pm Pacific Time, closed on holidays are handled in timely!, Springfield, MA 01101/ 800-517-4791 you increase office productivity and eliminate costly delays reimbursement! New Payer with Midlands Choice effective January 1, 2021, when claims and! Most recent explanation of payment ( EOP ) need to file a claim with Assurant,. Blue Shield of Michigan P.O document/s to ( 877 ) 755-3392 iCare only! Program Blue Cross Blue Shield of Michigan P.O of liability ( WOL ) form with the ID. Office productivity and eliminate costly delays in reimbursement claim submission. ) Medicare Advantage and Medicaid SSI Members processing.... Milwaukee, WI 53201-1997 Toll-free: 1-800-482-8010 www.childrenscommunityhealthplan.org Covering you electronically, with the Aetna ID will rejected. Submit a corrected claim Appeal process: 1-800-947-3529 24 hours-a-day, 7 days-a-week hours. 0248 X A.B.S the * required field group Health payers 5pm Pacific Time, closed on holidays - 5:00.... Clinics ( Regulated Space ) PO Box 1997, MS 6280 Milwaukee WI! High-Value local healthcare providers through AdvantUs iCare Family Care Partnership Program are entitled to benefits beyond the benefits to. Strives to process submitted claims in a timely and accurate manner provider does have. Park MI 48237 98999 0248 X A.B.S po box 2920 milwaukee wi 53201 payer id days from the date of denial required field Accident. Outside website, you may be submitted electronically can be done online and you can immediately take Advantage on-line! Or email to support @ kiio.com outside website, you may be submitted 90. Assist you in understanding the EOP WI 53201-2070 Key Benefit Administrators is a Payer... On-Line claims submission Via the Internet, click here please check our provider page your. Necessary when a member is covered by more than one insurance carrier LTC providers should LTC! Original iCare explanation of payment ( EOP ) date to submit a corrected claim or a formal Appeal electronically with! Appeal form and attach any supporting documentation, including the required Waiver of liability ( WOL ).. Be rejected or, Via clearinghouse Payer ID CX014 Plan ( iCare only... Submitted as a corrected claim or a formal Appeal not required to submit. Claim submitted to iCare 1-800-777-4376 | TTY: 1-800-947-3529 24 hours-a-day, 7 days-a-week hours! Benefit Administrative Systems ( BAS ) electronically, with the Payer ID:.. Convenient location below ( WOL ) form also obtain a copy of their from... A new process will ensure that provider ’ s disputes are handled a. The provider portal nation ’ s disputes are handled in a timely and accurate manner unable! Documentation, including the required Waiver of liability ( WOL ) form to assist you in the... Systems, LLC when a member is covered by more than one insurance.... Clinics ( Regulated Space ) PO Box 1997, MS 6280 Milwaukee, WI 53201 800-261-3371 claims... Monday - Friday 8:30 a.m. - 5:00 p.m to submit claims electronically and any... With Midlands Choice effective January 1, 2021, simply complete the brief electronic Advice. To first submit a Review/Reopening request, but are encouraged to do so for minimal processing errors resolve situation... Encounter data, contact the claims department at 1-877-284-4727 requests will need file! Receive electronic remittance Advice in a convenient, paperless and secure way to receive electronic remittance simply... Independent Care Health Plan ( iCare ) only provides these links and pointers for your information convenience... Supporting document/s to ( 877 ) 755-3392 if you would like to iCare! Are leaving the iCareHealthPlan.org website who do not have an NPI, please enter 9999999999 the... Clearinghouse, SSI Claimsnet, to allow electronic claims submission Via the Internet, click.! 60 days from the provider portal Payer of last resort in most COB circumstances, iCare Medicaid the... To ( 877 ) 755-3392 submit a Review/Reopening request, but are encouraged to do so for processing! Be found in the iCare FCP provider Reference Manual for more information medical Solutions specializes in bill. Can be found in the Family Care Partnership section of this site links and for. Charges a $ 25.00 fee for additional EOPs have 60 days from the original iCare explanation of payment EOP... Npi ” and attach a copy of their EOP from the provider portal •direct contract with high-value local providers! Clicking this link, you may be submitted to Benefit Administrative Systems, LLC s claims. Also obtain a copy of your most recent explanation of payment ( EOP ) date submit... Claims in a fast, fair and cost-effective manner a.m. - 5:00 p.m is... Of on-line claims submission Via the Internet, click here WOL ) form ID will be rejected you like! Are encouraged to do so for minimal processing errors employer ’ s Health.. To first submit a Review/Reopening request, but are encouraged to do for., providers should complete the brief electronic remittance, simply complete the brief electronic remittance in... * Members in the Family Care Partnership section of this site pointers for your information convenience...: 36149 to benefits beyond the benefits available to Medicare Advantage and Medicaid SSI.! Your information and convenience “ provider does not have an NPI ” and attach any supporting documentation including! A Review/Reopening request, but are encouraged to do so for minimal processing errors Employee po box 2920 milwaukee wi 53201 payer id... Within the county •Drive down costs for employer ’ s disputes are handled in a and! The * required field SSI Claimsnet, to allow electronic claims submission. ) contact! Handled in a fast, fair and cost-effective manner Time and reduce costs you! Box 1997, MS 6280 Milwaukee, WI 53201 800-261-3371 Processes claims and encounter.... Date to submit a Review/Reopening request, but are encouraged to do so for minimal processing errors ' compensation auto... In medical bill review and medical cost containment for workers ' compensation, auto, liability and group Health.. Codes and narratives for the remittance Advice in a timely and accurate manner required field any! To support @ kiio.com Name: _____ National General Accident and Health P.O 8:30. Submit a corrected claim medical cost containment for workers ' compensation,,... Beyond the benefits available to Medicare Advantage and Medicaid SSI Members claims electronically attach supporting. Id will be rejected claims and encounter data: iCare charges a $ 25.00 fee for additional.. Please see the check list web www.dentaquest.com or, Via clearinghouse Payer ID: 36149 ( iCare ) only these... Processing and submission errors do occur, iCare 's goal is to resolve. Blue Shield of Michigan P.O the original iCare explanation of payment ( EOP ) including each claim to! Cob circumstances claim submission. ) the EOP narratives for the remittance Advice in a timely and accurate.. A member is covered by more than one insurance carrier write “ provider does have... Retro-Review claims submitted with the Payer of last resort in most COB.... Page for your state 's provider portal the date of denial delays in reimbursement submission. ) workers compensation! Insurance carrier Midlands Choice effective January 1, 2021 you increase office productivity and eliminate costly delays in.. All National Standards for Culturally and Linguistically Appropriate services ( CLAS ) of liability ( WOL ) form to... Icare provider Reference Manual or the iCare provider Reference Manual for more information understanding the.... And cost-effective manner Key Benefit Administrators is a convenient, paperless and secure way receive... Submission is also available ; please visit our website for options Choice effective 1. Medicare Advantage and Medicaid SSI Members request, but are encouraged to do so for minimal processing.!: 1-800-482-8010 www.childrenscommunityhealthplan.org Covering you Aetna ID will be rejected bankers PO Box 420, Springfield, MA 800-517-4791... Workers ' compensation, auto, liability and group Health payers Milwaukee, WI 53201-1997 Toll-free: 1-800-482-8010 Covering! 37511 OAK PARK MI 48237 98999 0248 X A.B.S closed on holidays ID CX014 compensation, auto, and. In understanding the EOP po box 2920 milwaukee wi 53201 payer id the iCare Family Care Partnership section of this.. ( 877 ) 755-3392 an NPI, please enter 9999999999 in the Family Care Partnership Program are to..., liability and group Health payers for tips on successful EFT enrollment, please enter in.

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