Medicare claim status phone number for providers


medicare claim status phone number for providers

Healthcare Management Services via Provider Line: 1-800-547-3627, option 2 Customer Service department at the phone numbers listed below. The Customer. Before you call the Medicare phone number, read this helpful guide to or Medicare Part D coverage, contact your plan provider directly. Save yourself a phone call by checking claims status online. Advantage U Medicare: Appeals must be received within 60 calendar days from the date of.

Medicare claim status phone number for providers -

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Noridian Medicare Portal Noridian Medicare Portal

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New User?

Register for access to eligibility, claims, appeals and more.

Start Registration

You will need:
  • Unique email address
  • Tax ID/NPI/PTAN combination
  • Submitter ID (EDISS Connect account must be set up for A and B providers)
  • Recent check number and amount (Provider Administrators only - ensure a check has been issued by Noridian)

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This warning banner provides privacy and security notices consistent with applicable federal laws, directives, and other federal guidance for accessing this Government system, which includes all devices/storage media attached to this system. This system is provided for Government authorized use   only. Unauthorized or improper use of this system is prohibited and may result in disciplinary action and/or civil and criminal penalties. At any time, and for any lawful Government purpose, the government may monitor, record, and audit your system usage and/or intercept, search and seize any communication   or data transiting or stored on this system. Therefore, you have no reasonable expectation of privacy. Any communication or data transiting or stored on this system may be disclosed or used for any lawful Government purpose.

Источник: https://www.noridianmedicareportal.com/

Submit claim or check claim status

Troy Medicare HMO plans are currently only available in Robeson, Cumberland, Harnett, Sampson, Catawba, Alexander, Iredell, Moore, Hoke, Scotland, Bladen, Columbus, Richmond, Montgomery, Anson, Rowan, or Cabarrus counties in North Carolina.


Troy Medicare is an HMO plan with a Medicare contract. Enrollment in Troy Medicare depends on contract renewal.


This information is not a complete description of benefits. Call 1-888-494-TROY (8769) (TTY 711) for more information.

This document is available in alternative formats. If you need this document in an alternative format, call Member Service at 1-888-494-TROY (8769).

To report suspected incidents of non-compliance and/or fraud, waste or abuse, you can contact Troy Medicare directly or anonymously  in the following ways:

Reporting portal: troymedicare.ethicspoint.com

General Information

To increase the speed and accuracy with which your claims are processed, we recommend filing claims via Electronic Data Interchange (EDI).

Submit Claims

If electronic submission is not an option at this time, submit CMS-1500 or UB-04 claim forms to the following address:

University of Utah Health Plans
Attention: Claims Department
PO Box 45180
Salt Lake City, UT 84145-0180


Check Claims Status Online

Wondering if a claim was received? Finished processing? What was paid to the provider or what is member responsibility? Save yourself a phone call by checking claims status online.

  • Contracted providers with a secure account – View claims status via our Provider Portal
  • Noncontracted providers or contracted providers waiting for their U-Link account to be set up - View claims status via our Guest User Claim Status portal
    Notes for Guest Users:
    • 'Vendor TIN' refers to the Tax ID number your clinic uses for billing and reporting payments
    • 'Member ID' requires the full number displayed on the Member ID card, including suffixes

Contact Us

If you have any additional questions, feel free to contact us:

Hours: M–F, 8 am–6 pm
Phone: 888-271-5870

Forms

Appeals Rights

Appeal Rights

Advantage U Medicare: Appeals must be received within 60 calendar days from the date of initial determination notification.

Healthy U Medicaid: Appeals must be received within 60 days from the date on Notice of Action or EOB.

Neurobehavioral HOME: Appeals must be received within 60 days from the date the Notice of Action or EOB. 

UHCP, UUHP Group, and Individual Plans Appeals: Members have 180 days to appeal from Notice of Action Letter/EOB.

UNI & Miners: Please contact appeal coordinators at 801-587-6480 or 888-271-5870.

Please note: Effective January 1, 2016, the University of Utah Health Plans () will require that providers obtain consent from a Healthy U or UHCP member, to appeal on their behalf, for denied claims or referrals, relating to clinical services. A Clinical appeal means services that were denied in a pre-service review, or services that were billed and require medical review, that denied.   

Response Time

How long will it take for a decision to be made?

Medicare Advantage: 60 calendar days. Commercial:  45 calendar days.  Medicaid:  30 calendar days.  

If you or your provider believes your life or immediate health is in danger, you may ask for an expedited (quick) appeal by calling Customer Service at 801-587-6480. If we agree the decision needs to be made quickly, we will make a decision in three calendar days for U of U Health Plans/Group and Individual Plans or 72 hours for Healthy U Medicaid.

For Routine or Expedited Appeals:  Sometimes we may need more information. If so, we may take an additional 14 calendar days to make our decision. If we need to take extra time, we will send you a letter.  If you have U of U Health Plans Group or Individual Plans, we will call you to explain why we need more time.  We need your permission to take the extra time for the appeal review.

Fraud & Abuse

Utilization Review Guidelines

Источник: https://uhealthplan.utah.edu/providers/claims-appeals.php

Medicare Claims

What Is a Medicare Claim?

Medicare claims ask Medicare or your insurer to pay for medical services or care you have received. In almost all cases, your doctor or a hospital where you received care will send the claim directly to Medicare if you are covered by Medicare Part A or Part B.

If you have a Medicare Advantage plan, there is no claim. The private companies that administer these plans are under contract with Medicare and are paid a set amount each month.

For Part D prescription drug plans, the insurance company that administers the plan contracts with pharmacies. Both those preferred pharmacies as well as nonpreferred pharmacies not in your plan will bill the insurer. You may have to pay more out-of-pocket if you use a nonpreferred pharmacy.

When Do You Need to File a Medicare Claim?

You generally shouldn’t have to worry about filing a Medicare claim yourself. But in some rare cases, you may have to file one on your own.

In those cases, you must file a claim within 12 months of receiving medical care. If you miss that deadline, you may have to pay all the costs yourself.

You may have to file a claim yourself if you receive care from a nonparticipating Medicare provider or an opt-out provider.

Types of Providers Defined by Medicare

Participating Providers
Health care providers that accept Medicare and also accept the Medicare-approved amount for particular medical services or supplies.

Nonparticipating Providers
Health care providers who accept Medicare patients but don’t agree to Medicare-approved prices. They may charge you up to 15 percent more than the approved cost.

Opt-out Providers
Health care providers who simply do not accept Medicare.

If you receive health care services from a provider who opts out of Medicare, you can file a claim for a Medicare reimbursement. It will cover only the approved amount Medicare pays for the service, so you may have to pay out-of-pocket costs.

If Your Provider Doesn’t File in a Timely Manner

If the 12-month deadline to file a Medicare claim is approaching and your doctor hasn’t filed a claim for your care, you may have to file a Medicare claim yourself.

First you should contact the doctor or supplier and ask them to file a claim. If still they don’t, and the deadline is approaching, you should go ahead and file the claim yourself.

Check Your Claim Status

You should check your Medicare Summary Notice mailed to you every three months to see if claims have been filed for services or supplies you’ve received. You can also check the status at MyMedicare.gov. Check the deadline for filing your claim by calling 1-800-MEDICARE (1-800-633-4227).

Source: U.S. Centers for Medicare & Medicaid Services

Filing an Appeal

If you file a claim and Medicare or your insurer denies it, you may file a Medicare appeal. There are five levels of appeals. If you fail at one level, you can usually appeal to the next higher one.

What You Can Appeal to Medicare
  • When Medicare or your plan denies your request for a health care service, medical supply or drug you think should be covered, provided to you or continued.
  • When Medicare or your plan denies your request for the medical service, product or drug that you already received.
  • When Medicare or your plan denies your request to change the amount you pay for a service, product or drug.

Medicare also provides information on finding someone to help you file an appeal.

How to File a Medicare Claim

If you ever have to file a Medicare claim, you will need to fill out a special form and provide other detailed information to Medicare and/or your private insurer.

What Must Be Included in a Medicare Claim
  • A completed Patient’s Request for Medical Payment form you can download from the Medicare website.
  • An itemized bill from your doctor, supplier or other health care provider.
  • A detailed letter explaining the reasons why you are filing the claim such as why your health care provider refuses to file one, is unable to file one or if the provider is not enrolled in Medicare.
  • Any supporting documentation for your claim.

Once you gather the documents and complete the form, you will mail the materials to a contractor in your state who handles claims. You can find the address on the second page of the Patient’s Request form or by logging into your account at MyMedicare.gov.

Did You Know?

If you want someone to call 1-800-MEDICARE on your behalf, and you want Medicare to release your personal information to them, you will need to fill out an Authorization to Disclose Personal Health Information.

Source: U.S. Centers for Medicare & Medicaid Services

Medicare Claim FAQs

How do I check my Medicare claim status?

There are three ways to check your Medicare claim status:

  1. Your Medicare Summary Notice that arrives every three months will show which claims have been filed.
  2. You can log on to your account at MyMedicare.gov.
  3. You can call 1-800-MEDICARE (1-800-633-4227).
How do Medicare claims work with a Medigap plan?

Medicare will automatically send your claims to most Medigap insurers who will handle the payment. But some Medigap insurers will require you to file the claim with Medicare. If you do have to submit your own claim, you will need to send the insurer a Medicare Summary Notice that shows how much Medicare paid along with an invoice or receipt to show how much you paid out-of-pocket.

Last Modified: September 29, 2021

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Источник: https://www.retireguide.com/medicare/coverage/claims/

ACC Member Handbooks

You can request copies of the 2021 Mercy ACC Member Handbook. Just fill out the Mercy Care ACC Member Handbook Order Form and submit it to [email protected]

(Orders are processed on Fridays. Requests made on Thursdays after 5 p.m. will be processed the following week.)  

Pima County providers

Mercy Care is proud to continue serving ALTCS, DDD and Mercy Care Advantage (MCA) members in Pima County. We remain contracted with AHCCCS to provide services to members enrolled in ALTCS, DDD and MCA. If you have any questions, you can contact your Network Management representative.

Fast, easy answers to your questions

Mercy Care’s new Interactive Voice Response, or IVR, system, makes it easy to get member and claims information 24/7. You can:

  • Access member benefits and eligibility information
  • Get answers to Frequently Asked Questions ‑ such as appeals address, payer ID, etc.
  • Obtain claim status at header level
  • Obtain claim status at line level
  • Obtain amount paid on a specific claim
  • Request single claim information by fax

Find out more here.

Join our network

We appreciate your interest in joining Mercy Care’s network. We're committed to providing quality medical and behavioral health care services to our members. Mercy Care’s network is closed to most medical and behavioral health care providers. Currently, our network meets the needs of our membership and our letter of interest, contracting and credentialing processes help us achieve that goal.

AHCCCS (Arizona Health Care Cost Containment System) is Arizona’s Medicaid Managed Care Program. Mercy Care is contracted with AHCCCS to provide Medicaid covered benefits and services to Mercy Care members. Providers must register with the AHCCCS program to be eligible for payment reimbursement. Registered providers agree to abide by state laws and agree to accept the state Medicaid payment as payment in full. Arizona state law and your Mercy Care provider contract prohibits balance billing MC members for Medicaid covered services and benefits. 

Letter of Interest process

Mercy Care’s network is closed to most medical and behavioral health care providers. Currently, our network meets the needs of our membership. However, our network is evaluated regularly; if it is determined the network need has changed and services provided by your organization are warranted, a Network Management Representative will contact you directly. You may submit a potential future provider letter of interest and W-9 Form for review. Please be advised that an additional request received within one year from the date of this letter of interest will be considered a duplicate and will receive an automatic “No Thank you” response. Behavioral Health providers should include a summary description of programs, including target populations and age categories, specific models of care/therapies used, along with frequency of programming treatment.

Credentialing process (Completed only after Letter of Interest approval)

Mercy Care is a member of the Arizona Association of Health Plans (AzAHP) and participates in the AzAHP Credentialing Alliance whose aim is to make the credentialing and recredentialing process easier by eliminating duplication of efforts and reducing administrative burden. 

The Credentialing Alliance's streamlined process utilizes the Council for Affordable Quality Healthcare (CAQH) Universal Provider Datasource for all practitioner credentialing applications for all participating plans and a common paper application for all facility credentialing applications. The Credentialing Alliance also uses a common practitioner data form and organizational data form to collect information necessary for their contract review process and system loading requirements.

The Credentialing Alliance uses Aperture Credentialing for primary source verification (PSV) services for the alliance. Aperture performs the PSV once and shares the results with each participating plan that you authorize to receive it. 

Practitioners only - go to https://proview.caqh.org/Login to complete or update your CAQH application with the following information:

  • The location where you primarily practice
  • Primary credentialing contact information (name, address, phone, etc.)
  • Updated attestation
  • DEA license, state medical license, malpractice insurance certificate, proof of board certification or upcoming exam (if applicable), CMEs for prior three (3) years (if not board-certified)
  • Malpractice claims history
  • Physician Assistants (PA’s) only- upload a current copy of the delegated agreement with the supervising physician and your scope of practice to your CAQH application.
  • Additional details related to the Credentialing Alliance and some of the benefits you will see from it are listed below:,
    • A single date that allows one recredentialing process to satisfy the recredentialing requirement for each of the participating plans with which you contract. That date is the earliest date you are set to be recredentialed by any of the participating plans. Following the initial alliance recredentialing event, your next recredentialing date will be set three (3) years out.
    • For practitioner groups that are adding a new practitioner, you simply complete the common Practitioner Data Form once and send to each of the participating plans your group is contracted with. Practitioners must also make sure CAQH is updated and each of the participating plans that you are contracted with are approved to access your CAQH application. Please remember that adequately completing your CAQH application will help reduce credentialing timelines. Be sure to upload all supporting documents and that re-attestation is required every 120 days (reminders are sent out in the form of an email prior to expiration).
    • If you are a new practitioner, ancillary or facility, complete the appropriate common data form (Practitioner or Organizational) once and send to the participating plan(s) you wish to contract with. Facility/ancillary providers must also complete the common facility application.
    • If you are a practitioner that requires a site visit as part of the initial credentialing event (Primary Care Provider or Obstetrician) or a facility that requires a site visit as part of the initial credentialing event (facilities that are not accredited or surveyed), the participating plan(s) that you are requesting to contract with will have access to any site visit already performed under the alliance. If a site visit has already been performed by another participating plan in the Credentialing Alliance, another site visit will not be necessary. If no site visit has been performed by a participating plan in the AzAHP credentialing alliance, a single site visit will be performed as part of the initial credentialing event and made available to all participating plans.
    • Please complete the applicable form(s) below and email the completed form(s) and attachments to our Network Management Team at:
    • [email protected]

 Practitioners

Contracting process

To be eligible to join the Mercy Care and Mercy Care Advantage networks as a contracted provider, you must do the following:

  • Submit a potential provider Letter of Interest following the process outlined;
  • Be directly contacted by a Network Management Representative with an approved Letter of Interest to join our network;
  • Correctly and completely submit the credentialing application;
  • Be fully credentialed by Mercy Care or Mercy Care Advantage;
  • New providers will receive a Participating Health Provider Agreement (contract); and
  • Sign and return all contract documents.

Upon completion of credentialing and full execution of contract documents, the provider will receive notice from the Mercy Care Network Development department with the effective date of participation, along with the fully executed contract (if it is a new contract).

Providers should not schedule or see Mercy Care members until they are notified of the participation effective date.

New providers receive written confirmation of their effective date with the health plan. Members may not be seen until the provider receives written confirmation that a request or change is approved and completed (this includes approval by the Credentialing Committee and signed contract, if applicable).

Refer to our Provider Manual for more detailed information. Contracted providers can find reimbursement information in their Mercy Care contracts. Non-contracted providers can refer to the AHCCCS fee schedule for reimbursement information.

Our Network Management department serves as a liaison between Mercy Care and the provider community. Network Management is responsible for training, maintaining and strengthening the provider network in accordance with regulations.

If you need to check on the status of a claim, please use our secure web portal.   You may access the portal by clicking on the link in the top upper right hand corner of this web page under Find A Provider. You must be a registered user to access it. To register, please fill out our Registration Form. Please fax to the below number to start the process.  

If you have questions regarding a processed claim, either paid or denied, please feel free to contact our Customer Service department at 602-263-3000 or 800-624-3879. Non-participating providers should contact our Customer Service department for all issues, in addition to claims issues.

You can fax directly to Network Management at 860-975-3201 the following information:

  • Notifying the plan of changes to your practice
  • Tax ID changes
  • Recent practice or provider updates
  • Termination from practice
  • Web Portal Registration Form

 Please feel free to contact our Network Management department for the following:

  • Questions regarding the web portal Registration Form or to check on enrollment status
  • Credentialing requirements
  • Provider Education

You can reach our Network Management department by calling 602-263-3000 or 800-624-3879. For your convenience, below you can find a listing of your assigned Network Management representative, as well as their detailed contact information:

Источник: https://www.mercycareaz.org/providers/completecare-forproviders/

Contact Information

[Skip to Content]
Beacon Health Options

As a reminder, please ensure that you have completed your required Cultural Competency training. If you are a Practitioner, please visit CAQH, update your information, and attest that it is accurate. Provider Groups and Facilities may visit our provider portal or call our National Provider Service Line at 800-397-1630 to share your individual provider information.

  • Interested in joining the network?

    Follow the instructions on How to Become a Provider

  • Claims – General Information

    If you have questions about claims in general, call (800) 888-3944.

  • Claims Submission/ Address

    Reference the address on the member’s identification card, as the address may vary based on payment location.

  • Electronic Payment Solutions and Remittance Advice

    Register for Payspan to receive direct deposit of provider payments and access remittance data 24/7.

  • Member Benefits, Eligibility, and Authorizations

    If you have a question about authorization or benefits, call the (800) number on the back of the member’s identification card.

  • Member Customer Service

    To reach Member Customer Service, call the (800) number on the back of the member’s identification card.

  • Provider Supporting Documentation

    To send supporting documentation such as malpractice or insurance cover sheets please fax to (866) 612-7795

  • Regional Offices

    If you have general questions and would like to contact Provider Relations in your region, visit the list of our regional offices.

  • Electronic Claims Submission/ EDI Helpdesk

    If you have a technical question about ProviderConnect or EDI Claim Submission, please contact the EDI Helpdesk at:

    Phone:(888) 247-9311 from 8 a.m.-6 p.m. ET, Monday through Friday
    Fax:(866) 698-6032
    E-mail:[email protected]
    Mailing Address:Beacon Health Options
    Attn: EDI Helpdesk
    PO Box 1287
    Latham, NY 12110
  • Credentialing Status

    To obtain information pertaining to your network status, contact our National Provider Line at (800) 397-1630 from 8 a.m.-8 p.m. ET.

  • Fraud and Abuse

    Reports of fraud and abuse, or suspicions thereof, can be made in writing to:

    Mailing Address:Beacon Health Options
    ATTN:  Special Investigations Unit
    1400 Crossways Blvd
    Suite 101
    Chesapeake, VA 23320
  • Clinical Appeals

    To request a clinical appeal on a member’s behalf, call the (800) number included in the adverse determination letter you received.

  • Administrative Appeal

    To request an administrative appeal, call the (800) number included in the administrative denial letter you received.

  • Complaints/Grievances

    To file a complaint/grievance, call the (800) number on the back of the member’s identification card to speak to Customer Service.

  • Adverse Incident

    Report all adverse incidents to the Clinical Care Manager with whom you conduct reviews.

  • Duty to Warn

    Report all potential situations to the Clinical Care Manager with whom you conduct reviews.

  • Provider Coverage During Absences

    Contact the Clinical Care Manager with whom you conduct reviews during absences (i.e. coverage while on vacation). Or call the number on the card to provide coverage information.

  • Changing your Provider Profile (e.g. Name, address)

    The preferred method to updated your provider profile is to select the “Update Demographic Information” option in ProviderConnect. Please note: Updating a Tax ID requires an accompanying W-9 form, which can be accessed and attached through ProviderConnect.

    Fax:(866) 612-7795
    Mail Address:Beacon Health Options
    c/o Practitioner Maintenance
    P.O. Box 989
    Latham, NY 12110

General Information

  • “More than 4,500 employees nationally, serving more than 40 million people.”

  • “Over 260 clients, including employers, Fortune 500 companies, health plans, and state and local governments.”

Copyright © 2022 Beacon Health Options. All rights reserved.

Источник: https://www.beaconhealthoptions.com/providers/beacon/contact-information/

: Medicare claim status phone number for providers

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medicare claim status phone number for providers

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Medicare Live Ep 1.2 Medical Billing is Important for Providers \u0026 Beneficiaries! EOB explained.

Providers

aetna logo

It’s easy to get the information you need

Use your Practice Management Software or our secure provider portal to seamlessly submit and track Medicare transactions. Submit electronic claims to Medicare for all Medicare covered services.

Provider eligibility verification(No login required)

Add us to the Payer list in your Practice Management Software
Use Payer ID AESSI to submit eligibility, benefit, and claim status inquiries. Use Payer ID 62118 to view claim payments and explanations.
Don’t have Practice Management Software?
Use our secure portal to check eligibility, claims status, and explanation of payments.

Sign up for secure portal

Medicare claim status phone number for providers payments issued after July 23rd, 2021, use the provider payment portal to view explanation of payments.

Provider Payment Portal

To enroll in EFT or ERA, call to speak with a representative at 888-837-2964.

Reference guides:

Companion guides about real time transactions:

Copyright © 2021 Aetna Inc.

Источник: https://www.aetnaseniorproducts.com/ssi/providers.html

Medicare Claims

What Is a Medicare Claim?

When Do You Need to File a Medicare Claim?

You generally shouldn’t have to worry about filing a Medicare claim yourself. But in some rare cases, you may have to file one on your own.

In those cases, you must file a claim within 12 months of receiving medical care. If you miss that deadline, you may have to pay all the costs yourself.

You may have to file a claim yourself if you receive care from a nonparticipating Medicare medicare claim status phone number for providers or an opt-out provider.

Types of Providers Defined by Medicare

Participating Providers
Health care providers that accept Medicare and also accept the Medicare-approved amount for particular medical services or supplies.

Nonparticipating Providers
Health care providers who accept Medicare patients but don’t agree to Medicare-approved prices. They may charge you up to 15 percent more than the approved cost.

Opt-out Providers
Health care providers who simply do not accept Medicare.

If you receive health care services from a provider who opts out of Medicare, you can file a claim for a Medicare reimbursement. It will cover only the approved amount Medicare pays for the service, so you may have to pay out-of-pocket medicare claim status phone number for providers Your Provider Doesn’t File in a Timely Manner

If the 12-month deadline to file a Medicare claim is approaching and your doctor hasn’t filed a claim for your care, you may have to file a Medicare claim yourself.

First you should contact the doctor or supplier and ask cheap apartments in edmond ok near uco to file a claim. If still they don’t, and the deadline is approaching, you should go ahead and file the claim yourself.

Check Your Claim Status

You should check your Medicare Summary Notice mailed to you every three months to see if claims have been filed for services or supplies you’ve received. You can also check the status at MyMedicare.gov. Check the deadline for filing your claim by calling 1-800-MEDICARE (1-800-633-4227).

Source: U.S. Centers for Medicare & Medicaid Services

Filing an Appeal

If you file a claim and Medicare or your insurer denies it, you may file a Medicare appeal. There are five levels of appeals. If you fail at one level, you can usually appeal to the next higher one.

What You Can Appeal to Medicare
  • When Medicare or your plan denies your request for a health care service, medical supply or drug you think should be covered, provided to you or continued.
  • When Medicare or your plan denies your request for the medical service, product or drug that you already received.
  • When Medicare or your plan denies your request to change the amount you pay for a service, product or drug.

Medicare also provides information on finding someone to help you file an appeal.

How to File a Medicare Claim

If you ever have to file a Medicare claim, you will need to fill out a special form and provide other detailed information to Medicare and/or your private insurer.

What Must Be Included in a Medicare Claim
  • A completed Patient’s Request for Medical Payment form you can download from the Medicare website.
  • An itemized bill from your doctor, supplier or other health care provider.
  • A detailed letter explaining the reasons why you are filing the claim such as why your health care provider refuses to file one, is unable to file one or if the provider is not enrolled in Medicare.
  • Any supporting documentation for your claim.

Once you gather the documents and complete the form, you will mail the materials to a contractor in your state who handles claims. You can find the address on the second page of the Patient’s Request form or by logging into your account at MyMedicare.gov.

Did You Know?

If you want someone to call 1-800-MEDICARE on your behalf, and you want Medicare to release your personal information to them, you will need to fill out an Authorization to Disclose Personal Health Information.

Source: U.S. Centers for Medicare & Medicaid Services

Medicare Claim FAQs

How do I check my Medicare claim status?

There are three ways to check your Medicare claim status:

  1. Your Medicare Summary Notice that arrives every three months will show which claims have been filed.
  2. You can log on to your account at MyMedicare.gov.
  3. You can call 1-800-MEDICARE (1-800-633-4227).
How do Medicare claims work with a Medigap plan?

Medicare will automatically send your claims to most Medigap insurers who will handle the payment. But some Medigap insurers will require you to file the claim with Medicare. If you do have to submit your own claim, you will need to send the insurer a Medicare Summary Notice that shows how much Medicare paid along with an invoice or receipt to show how much you paid out-of-pocket.

Last Modified: September 29, 2021

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Источник: https://www.retireguide.com/medicare/coverage/claims/

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Select a subject below for contact information.

Claims

Questions about claims status, appeals and payments, authorization and general coding (not how to bill).
Save time by using our secure Claim Status Inquiry tool. Sign in

Resources
Submit a claim appeal
Submit a claim adjustment
Submit a claim attachment
Submit a claim inquiry
Medical claim policies


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Dental651-265-1000 / 800-642-1323651-265-1001M-F, 7am-5pm CT

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9 a.m. to 4 p.m., CT

ProductPhoneFaxTTY
Commercial952-883-5000 / 800-883-2177952-883-5666952-883-5127 /
888-850-4762
Medicare Cost952-883-7979 / 800-233-9645952-883-7666952-883-6060 /
800-443-0156
Medicare Advantage888-360-0544952-883-7333800-443-0156
MN Health Care Programs (MHCP)952-967-7998 / 866-885-8880952-883-7666952-883-6060 /
800-443-0156

Contracting and Payer Relations

Credentialing

Check on the status of existing credentialing requests. Providers must already be contracted or working for a contracted provider to start the credentialing process.

  • Please note that contracting requests are managed separately by the Contracting and Payer Relations department.

Submit a credentialing inquiry

PhoneFax
952-883-5755 / 866-630-0188952-853-8702

Other resources
More about credentialing, visit credentialing and enrollment

Dental administration and contracting

Medical management

Type of carePhoneFax
General Medical Mgmt952-883-7888 / 877-499-7888952-853-8713
Disease & Case Mgmt952-883-5469 / 800-871-9243952-853-8745
Inpatient Case Mgmt952-883-6277 / 800-255-1886 x36277952-853-8748
HealthPartners Connect952-883-5469 / 800-871-9243952-853-8745
Hospital admission notification952-883-6400 / 800-316-9807952-853-8705

Prior authorization program
Prior authorization for services such as: procedures, habilitative, rehabilitation, skilled nursing facility, home care, hospice, personal care attendant, and dme. See prior authorization list for details.

952-883-6333 / 888-467-0774

Behavioral health

Quality measurement and improvement

Pharmacy administration

e-Services

Источник: https://www.healthpartners.com/provider-public/forms/contact-us.html

ACC Member Handbooks

You can request copies of the 2021 Mercy ACC Member Handbook. Just fill out the Mercy Care ACC Member Handbook Order Form and submit it to [email protected]

(Orders are processed on Fridays. Requests made on Thursdays after 5 p.m. will be processed the following week.)  

Pima County providers

Mercy Care is proud to continue serving ALTCS, DDD and Mercy Care Advantage (MCA) members in Pima County. We remain contracted with AHCCCS to provide services to members enrolled in ALTCS, DDD and MCA. If you have any questions, you can contact your Network Management representative.

Fast, easy answers to your questions

Mercy Care’s new Interactive Voice Response, or IVR, system, makes it easy to get member and claims information 24/7. You can:

  • Access member benefits and eligibility information
  • Get answers to Frequently Asked Questions ‑ such as appeals address, payer ID, etc.
  • Obtain claim status at header level
  • Obtain claim status at line level
  • Obtain amount paid on schwinn mountain bike walmart specific claim
  • Request single claim information by fax

Find out more here.

Join our network

We appreciate your interest in joining Mercy Care’s network. We're committed to providing quality medical and behavioral health care services to our members. Mercy Care’s network is closed to most medical and behavioral health care providers. Currently, our network meets the needs of our membership and our letter of interest, contracting and credentialing processes help us achieve that goal.

AHCCCS (Arizona Health Care Cost Containment System) is Arizona’s Medicaid Managed Care Program. Mercy Care is contracted with AHCCCS to provide Medicaid covered benefits and services to Mercy Care members. Providers must register with the AHCCCS program to be eligible for payment reimbursement. Registered providers agree to abide by state laws and agree to accept the state Medicaid payment as payment in full. Arizona state law and your Mercy Care provider contract prohibits balance billing MC members for Medicaid covered services and benefits. 

Letter of Interest process

Mercy Care’s network is closed to most medical and behavioral health care providers. Currently, our network meets the needs of our membership. However, our network is evaluated regularly; if it is determined the network need has changed and services provided by your organization are warranted, a Network Management Representative will contact you directly. You may submit a potential future provider letter of interest and W-9 Form for review. Please be advised that an additional request received within one year from the date of this letter of interest will be considered a duplicate and will receive an automatic “No Thank medicare claim status phone number for providers response. Behavioral Health providers should include a summary description of programs, including target populations and age categories, specific models of care/therapies used, along with frequency of programming treatment.

Credentialing process (Completed only after Letter of Interest approval)

Mercy Care is a member of the Arizona Association of Health Plans (AzAHP) and participates in the AzAHP Credentialing Alliance whose aim is to make the credentialing and recredentialing process easier by eliminating duplication of efforts and reducing administrative burden. 

The Credentialing Alliance's streamlined process utilizes the Council medicare claim status phone number for providers Affordable Quality Healthcare (CAQH) Universal Provider Datasource for all practitioner credentialing applications for all participating plans and a common paper application for all facility credentialing applications. The Credentialing Alliance also uses a common practitioner data form and organizational data form to collect information necessary for their contract review process and system loading requirements.

The Credentialing Alliance uses Aperture Credentialing for primary source verification (PSV) services for the alliance. Aperture performs the PSV once and shares the results with each participating plan that you authorize to receive it. 

Practitioners only - go to https://proview.caqh.org/Login to complete or update your CAQH application with the following information:

  • The location where you primarily practice
  • Primary credentialing contact information (name, address, phone, etc.)
  • Updated attestation
  • DEA license, state medical license, malpractice insurance certificate, proof of board certification or upcoming exam (if applicable), CMEs for prior three unemployment reliacard customer service years (if not board-certified)
  • Malpractice claims history
  • Physician Assistants (PA’s) only- upload a current copy of the delegated agreement with the supervising physician and your scope of practice to your CAQH application.
  • Additional details related to the Credentialing Alliance and some of the benefits you will see from it are listed below:,
    • A single date that allows one recredentialing process to satisfy the recredentialing requirement for each of the participating plans with which you contract. That date is the earliest date you are set to be recredentialed by any of the participating plans. Following the initial alliance recredentialing event, your next recredentialing date will be set three (3) years out.
    • For practitioner groups that are adding a new practitioner, you simply complete the common Practitioner Data Form once and send to each of the participating plans your group is contracted with. Practitioners must also make sure CAQH is updated and each of the participating plans that you are contracted with are approved to access your CAQH application. Please remember that adequately completing your CAQH application will help reduce credentialing timelines. Be sure to upload all supporting documents and that re-attestation is required every 120 days (reminders are sent out in the form of an email prior to expiration).
    • If you are a new practitioner, ancillary or facility, complete the appropriate common data form (Practitioner or Organizational) once and send to the participating plan(s) you wish to contract with. Facility/ancillary providers must also complete the common facility application.
    • If you are a practitioner that requires a medicare claim status phone number for providers visit as part of the initial credentialing event (Primary Care Provider or Obstetrician) or a facility that requires a site visit as part of the initial credentialing event (facilities that are not accredited or surveyed), the participating plan(s) that you are requesting to contract with will have access to any site visit already performed under the alliance. If a site visit has already been performed by another participating plan in the Credentialing Alliance, another site visit will not be necessary. If no site visit has been performed by a participating plan in the AzAHP credentialing alliance, a single site visit will be performed as part of the initial credentialing event and made available to all participating plans.
    • Please complete the applicable form(s) below and email the completed form(s) and attachments to our Network Management Team at:
    • [email protected]

 Practitioners

Contracting process

To be eligible to join the Mercy Care and Mercy Care Advantage networks as a contracted provider, you must do the following:

  • Submit a potential provider Letter of Interest following the process outlined;
  • Be directly contacted by a Network Management Representative with an approved Letter of Interest to join our network;
  • Correctly and completely submit the credentialing medicare claim status phone number for providers fully credentialed by Mercy Care or Mercy Care Advantage;
  • New providers will receive a Participating Health Provider Agreement (contract); and
  • Sign and return all contract documents.

Upon completion of credentialing and full execution of contract documents, the provider will receive notice from the Mercy Care Network Development department with the effective date of participation, along with the fully executed contract (if it is a new contract).

Providers should not schedule or see Mercy Care members until they are notified of the participation effective date.

New providers receive written confirmation of their effective date with the health plan. Members may not be seen until the provider receives written confirmation that a request or change is approved and completed (this includes approval by the Credentialing Committee and signed contract, if applicable).

Refer to our Provider Manual for more detailed information. Contracted providers can find reimbursement information in their Mercy Care contracts. Non-contracted providers can refer to the AHCCCS fee schedule for reimbursement information.

Our Network Management department serves as a liaison between Mercy Care and the provider community. Network Management is responsible for training, maintaining and strengthening the provider network in accordance with regulations.

If you need to check on the status of a claim, please use our secure web portal.   You may access the portal by clicking on the link in the top upper right hand corner of this web page under Find A Provider. You must be a registered user to access it. To register, please fill out our Registration Form. Please fax to the below number to start the process.  

If you have questions regarding a processed claim, either paid or denied, please feel free to contact our Customer Service department at 602-263-3000 or 800-624-3879. Non-participating providers should contact our Customer Service department for all issues, in addition to claims issues.

You can fax directly to Network Management at 860-975-3201 the following information:

  • Notifying the plan of changes to your practice
  • Tax ID changes
  • Recent practice or provider updates
  • Termination from practice
  • Web Portal Registration Form

 Please feel free to contact our Network Management department for the following:

  • Questions regarding the web portal Registration Form or to check on enrollment status
  • Credentialing requirements
  • Provider Education

You can reach our Network Management department by calling 602-263-3000 or 800-624-3879. For your convenience, below you can find a home building savings bank washington your assigned Network Management representative, as well as their detailed contact information:

Источник: https://www.mercycareaz.org/providers/completecare-forproviders/

Medicare Providers

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Cigna HealthCare of South Carolina, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Arizona, Inc., Cigna HealthCare of St. Louis, Inc., HealthSpring Life & Health Insurance Company, Inc., HealthSpring of Florida, Inc., Bravo Health Mid-Atlantic, Inc., and Bravo Health Pennsylvania, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

Cigna-HealthSpring is contracted with Medicare for PDP plans, HMO and PPO plans in select states, and with select State Medicaid programs. Enrollment in Cigna-HealthSpring depends on contract renewal.

Selecting these links will take you away from Cigna Medicare Advantage and Medicare Part D Prescription Drug Plan information.

This web site uses files in Adobe Acrobat Portable Document Format (PDF). This is useful for forms that you want to view medicare claim status phone number for providers print. To view or print these files, you must download and install the free Adobe Acrobat Reader. Get Adobe Reader

© 2020 Cigna. All rights reserved.

Источник: https://medicareproviders.cigna.com/
medicare claim status phone number for providers
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