A private, non-profit organization whose mission is to help people living with mental illness, their families, and the community. Box 21800 Eagan, MN 55121-0800. Important Information: In a medical emergency, call 9-1-1 or go to the nearest emergency facility. Please refer to our Receiver and Payer ID codes document. endstream endobj 111 0 obj <>/Metadata 4 0 R/Pages 3 0 R/StructTreeRoot 6 0 R/Type/Catalog/ViewerPreferences<>>> endobj 112 0 obj >/PageWidthList<0 612.0>>>>>>/Resources<>/Font<>/ProcSet[/PDF/Text]/Properties<>/XObject<>>>/Rotate 0/StructParents 0/TrimBox[0.0 0.0 612.0 792.0]/Type/Page>> endobj 113 0 obj [114 0 R 115 0 R 116 0 R] endobj 114 0 obj <>/Border[0 0 0]/H/N/Rect[137.765 120.667 232.038 89.1601]/StructParent 3/Subtype/Link/Type/Annot>> endobj 115 0 obj <>/Border[0 0 0]/H/N/Rect[64.8 252.858 163.067 238.748]/StructParent 1/Subtype/Link/Type/Annot>> endobj 116 0 obj <>/Border[0 0 0]/H/N/Rect[79.9742 164.658 178.241 150.548]/StructParent 2/Subtype/Link/Type/Annot>> endobj 117 0 obj <> endobj 118 0 obj <> endobj 119 0 obj <>stream Our Corporate Street Address: Univera Healthcare 205 Park Club Lane Buffalo, NY 14221. 0000018247 00000 n To check on the status of a claim, please check our Provider Portal. 0000148668 00000 n 1000 or toll free -3863 ext. 0000007911 00000 n Benefits and Eligibility. PO Box 21482 Eagan, MN 55121 If the claim form is not properly completed, it cannot be processed, and it will be returned. When you use a CIGNA PPO provider, your dentist will submit your claims for you. Service: 877-874-6385 Sales: 212-300-0739 Fax: 212-214-0892 Claims mailing address:Premera Blue Cross of WashingtonPO Box 21702Eagan, MN 55121. 0000000996 00000 n P.O. h\/qmt#KMt `(jthI&&){d*m[5$BXU\'X`TV/Vg9Aei3Uoh #2ImJbl 0000099007 00000 n Baylor Scott & White Health Plan ATTN: Claims Review Dept. Bind Benefits, Inc., may be entered as the "insurance" carrier (dependent on your system). Explore Products Individual & Family Plans Sole Proprietor Plans P.O. 0000098440 00000 n 0000098723 00000 n There's an option to submit HCFA (CMS 1500) claims on the new Individual secure website, however this function isn't available yet. 0000031511 00000 n <4-N'p$RZh "('("1 \D1/Yp;BF)/ 6|>PpyJ%adnN5M5&@2=quWzFYB&-: 0000002922 00000 n | trailer 0000142368 00000 n . 0000217182 00000 n MEDICAL CLAIM FORM Claims Receipt Center P.O. 0000025262 00000 n 0000001684 00000 n 0000005066 00000 n Medical Claim. Claims and Benefits Billing Address: ArchCare Advantage c/o Peak TPA P.O. endstream endobj 11 0 obj <> endobj 12 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC/ImageI]/XObject<>>>/Rotate 0/Type/Page>> endobj 13 0 obj <>stream Box 211422, Eagan, MN 55121 PPO Network Your patient's health plan accesses no network. At 90 Degree Benefits we know your patients are your priority and we know the importance of providing comprehensive health plan information 24/7 so you can find what you need quickly and get back to what you do best care for our patients. 0000124061 00000 n Box 211395 Eagan, MN 55121. 0000020931 00000 n Eagan Post Office 3145 Lexington Ave S, Eagan MN 55121 About Address: 3145 Lexington Ave S, Eagan MN 55121 Large Map & Directions Phone: 651-405-3068 Fax: 651-454-9478 TTY: 877-889-2457 Toll-Free: 1-800-Ask-USPS (275-8777) Retail Hours: Monday: 9:00AM - 5:00PM Tuesday: 9:00AM - 5:00PM Wednesday: 9:00AM - 5:00PM Thursday: 9:00AM - 5:00PM | To learn more about benefits, visit our educational resources page. No provider contracts are needed, network contracting and &R6onao``?Ggw0aii+-XhX15-YZmlcdo5x7r[B2@mn=Q)adp_& ngtq+`I>\hf[[p(n/\2Qz-fq\>N[i;Hu L#24Z4J#'a|nv#}whH " _`qI2Y,c0#fe|0=A[aK"(*0 @4>)*>W\DJR$&}I2':DefmZ=Zbabr+M!ZF:El" 9}bF{Fs#D| 84 wvmlmW}(-c Akd@=rlwVwtp4S8`? 0000099546 00000 n Oromoo | 0000024636 00000 n Box 211422, Eagan, MN 55121* *Unless otherwise stated on Medical ID card. 0000217143 00000 n Box 5267 Binghamton, NY 13902-5267. PO Box 211758 Eagan, MN 55121 After a claim has been submitted, quickly check claims status on UHSS.UMR.comor call 1-844-368-6661 to speak with a specially trained UnitedHealthcare Shared Services Provider Service Representative. 0000004497 00000 n Contact Us - Blackhawk Claims Service GA, Inc. About Blackhawk Products Providers Brokers Employers Members Contact Us CONTACT US Do you have a question about getting a quote or filing a claim? 0000080492 00000 n Box 676015 Chicago, IL 60695-6015 . 0000000016 00000 n 0000189889 00000 n Eligibility. 0000123789 00000 n It's possible your clearinghouse may assign us a custom payer ID. hbbd```b``"dd"l0[L^d`2LnS5glg$VQ5D:sn A^ You can continue to submit claims electronically as you do today. Updates to this listing have stopped. Box 21155 Eagan, MN 55121. Box 21013, Eagan, MN 55121 Ph: (610) 933-0800 | Fx: (610) 933-4122 claims@agadm.com 351 0 obj <> endobj %%EOF . Email Us Customer Service for Members Toll-free: 877.832.1823 Local: 608.395.6594 Customer Service for Providers Page | 4 Medical Coverages & Limitations Please keep this page for your records. color, national origin, age, disability, sex, gender identity, or sexual orientation. P.O. Box 211595 Eagan, MN 55121 What is the Payer ID? 0000132796 00000 n 219 0 obj <>stream 0000101370 00000 n 8mg7Rs:cPMc? 0000005608 00000 n Claims Status We've used 2 TPAs over my 20 years here. P.O. 0000022828 00000 n )9}p;;c"HC2#Zdd%/1y*@/A"yPS o 0000074637 00000 n PPO - HealthEOS by MultiPlan, P.O. Evolent Health (Evolent) will adjudicate all claims for 2020 Individual Plans. Once you fill out the claim form, mail it to: FirstCare Health Plans P.O. 0000016912 00000 n 0000008457 00000 n 0 374 0 obj <>stream Alliance Medical Supplement For Customer Care & Claims, contact AmFirst Insurance Company: (888) 888-2519 For Sales & Product Inquires, contact Lakeshore Benefit Alliance: (205) 703-9300 Select the tab that best describes you and submit form to contact us via email. If you accidently mail to the Premera commercial PO Box, Premera will forward the claim to Evolent. xref 0000024169 00000 n Box 211308, Eagan, MN 55121-2908 contactcustomerservice@fallonhealth.org (800) 868-5200 None None Harvard Pilgrim Health Care, Inc. 96911 1600 Crown Colony Drive, P.O. Provides general information of interest to the autism community. P.O. For reimbursement of covered prescription drug claims. or sexual orientation.Premera Blue Cross HMO complies with applicablefederal and Washington state civil rights lawsand does not discriminate on the basis of race, Non-PPO Dental Coverage 0000021452 00000 n You can also call the Member Services number on your ID card. 0000003098 00000 n | 0000021063 00000 n PO Box 211256 Eagan, MN 55121. | xref Mail Forms and Payments. Contact HealthEZ for reimbursement rates for any facility based care. 6 35 0000002546 00000 n You may notice slight differences in allowed amounts when compared to Premera due to rounding, edits, or fee schedule update timing, among other factors. P.O. 0000017049 00000 n Franais | Payer ID: ARGUS NEA: 451001 Argus Dental & Vision, Inc. Claims Department PO Box 211276 Eagan, MN 55121 2. Espaol | 0000201478 00000 n %PDF-1.6 % hmo0;?R(lX1";Ju 0000074523 00000 n P.O. EDI Payer ID: PCU02 . 0000143030 00000 n 0000002220 00000 n In the meantime, you can sign up for Office Ally, a full-service clearinghouse offering a web-based service where providers can submit claims to Participating Payers (Premera included) at no cost. Box 37200 Albuquerque, NM 87176. 0000010308 00000 n MEMBER. 0 0000080042 00000 n Box 16275 Reading, PA 19612 Bright HealthCare . Prime. The Healthfirst Coordinated Benefits Plan is a Medicare Advantage plan that offers the benefits of Original Medicare, plus dental, hearing, vision, transportation, SilverSneakers fitness program, and 24/7 access to care via phone or video chat and the Nurse Help Line. %PDF-1.4 % Clearinghouses may update submission rules. Electronic Remittance (ERA) 0000182114 00000 n <]/Prev 222131/XRefStm 2922>> Important Information: In a medical emergency, call 9-1-1 or go to the nearest emergency facility. Information for providers Learn more 0000024430 00000 n | 0000199768 00000 n Claim Review Process. P.O. qNB'C('T\?hlTBE1LpAWo(;Td-@atX0Y!5 ,q,E2("X5+a% Direct Premium Payments. 0000128196 00000 n 0000124384 00000 n 110 110 P.O. 0000022579 00000 n General Point of Contact. Box 211221, Eagan, MN 55121 Also note Paper claim submissions that have multiple pages to a claim should only have the total of the claim submitted on the last page Quartz requires diagnosis codes on dental claims 0000133532 00000 n Tagalog | 0000081242 00000 n If you submit paper claims, continue to use the industry standard claims form and mail it to the. 0000124411 00000 n 0000125003 00000 n Claims & Correspondence Information Claims can be filed electronically or by mail. Kreyl Ayisyen | Office Allys online claim entry allows you to create CMS1500, UB04, and ADA claims on their website; or you can use your existing software to create and submit claims electronically. 0000006300 00000 n | And, you don't need referrals to see in-network specialists. There have been two test cases in relation to business interruption cover and COVID-19 impacts. This listing may be off the market. Featured In: October 2020 Empire Provider News. 0000007141 00000 n Send general mail to: Box 699187, Quincy, MA 02169 Telephone is preferred method of contact. 0000106646 00000 n Or you can submit a paper HCFA (CMS 1500) claim to the address above. How do I become a WPS provider? 0000031074 00000 n Availity is solely responsible for its products and services. i:&roXq%aVC; $uYTHk:9$p ImrJ::P34jWj\lC%4ucGcN96gmNl1f YES. Claims mailing addresses. Claims address: Bind, P.O. Please be advised that we do not accept email or faxed claims, and any claims sent to us via the mail will incur a fee. 0000003447 00000 n Send monthly premiums to: WEA Insurance P.O. 0000074375 00000 n PO Box 1731 Portland, ME 04104 Mailing addresses. PO Box 211342 Eagan, MN 55121 Prior Authorization: 1-800-884-4905 Card Issue Date: 12/01/2019 FOR MEMBERS This card is for identification only and does not guarantee current membership or coverage. Mon - Thurs | 7am - 5pm. Our representatives are available Weekdays 9 a.m . %%EOF Contact Varipro with any questions or comments. Claims Submission Requirements. Provider Reference Guide - Baylor Scott & White Health Plan Claims mailing address: Premera Blue Cross of Washington. Acceptance of this card should indicate acceptance of the Plan's benefits as payment in full for services provided. For over two decades, AmFirst has stood strong, stable and secure in both good and difficult economic times, ready to meet the needs of its policyholders. PO Box 21531 Eagan, MN 55121 TO FILE A GRIEVANCE, PLEASE MAIL OR FAX TO: Reserve National Insurance Company ("Kemper Health") PO Box 26620 Oklahoma City, Oklahoma 73126-9958 Fax: 405.254.2111 or 1.877.877.0078 . Denver Health Medicaid Choice P.O. While Bind leverages the UnitedHealthcare network, Bind members must present a Bind member ID card to your staff. Premera Blue Cross complies with applicable federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, 0000005482 00000 n 0000018062 00000 n 0000189592 00000 n Box 21545 Eagan, MN 55121 : Eligibility, benefits, and claims status: customerservice@ahatpa.com Contract rates and network status: provrelations@ahatpa.com Website: www.ahatpa.com: The AmeriHealth Administrators website was recently redesigned, and the Providers page continues to give access to the NaviNet . Visit Availity.com or call Provider Services. The following summaries about po box 211472 eagan mn 55121 will help you make more personal choices about more accurate and faster information. 0000024920 00000 n Eagan, MN 55121. Get in touch 100 Decker Ct, Suite 250 866-910-6166 Outreach@blackhawktpa.com Name (required) Email (required) Message Box 211438 Eagan, MN 55121. 0000031152 00000 n This listing is NOT an active listing. For submitting medical claims. Create a Free Account Box 689511 Chicago, IL 60695-9511 . 0000061443 00000 n Learn More Filing an Appeal <<7496874096966B49874FF83460F5D92C>]/Prev 156940>> 0000211984 00000 n 0000189308 00000 n 0000080519 00000 n Contact A-G via mail, phone, fax and email: A-G Administrators LLC Attn: Springfield Claims P.O. endstream endobj 352 0 obj <>/Metadata 5 0 R/Pages 349 0 R/StructTreeRoot 9 0 R/Type/Catalog>> endobj 353 0 obj <>/MediaBox[0 0 1008 612]/Parent 349 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 354 0 obj <>stream Electronic Services Available (EDI) Professional/1500 Claims. 0000078005 00000 n 0000061195 00000 n No further information is available at this time. Customer Service: 1-800-884-4901 (TTY/TDD . endstream endobj 7 0 obj <> endobj 8 0 obj <> endobj 9 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text/ImageC/ImageI]/XObject<>>> endobj 10 0 obj <> endobj 11 0 obj <> endobj 12 0 obj [/Indexed/DeviceRGB 255 23 0 R] endobj 13 0 obj <>stream PO Box 21051 Eagan, MN 55121-0051. 0000138523 00000 n PO Box 211197 Eagan, MN 55121 Electronic Payor ID #43185 (918) 615-7972 . 0000010206 00000 n PO Box 211342 Eagan, MN 55121-0800 Electronic Claims The Availity Payor ID will be 94999. ]B ef-kg@Lc 0000004323 00000 n Note: When submitting claims under this payer ID, use only the 10-digit member ID. 0000147925 00000 n For Part-timers to submit with EOB or visit summary. 0000002656 00000 n Grace periods and claims pending policies during the grace period Box 211342 Eagan, MN 55121 Do you need to file for reimbursement on a prescription pharmacy claim? . All claims are processed at the Maximum Allowable Charge, generally a certain percentage above your Medicare rate. 0000205654 00000 n 0000011981 00000 n HTn0+x$EM)*"Fm4! We are excited about what our future holds and look forward to continuing to serve our policy holders with superior . 0000081070 00000 n 0000001294 00000 n Complete a claim review form within 60 days of EOP receipt. 0000137826 00000 n 0000205016 00000 n 38999 None (617) 509-1483 Are you an employer? Box 211256 Eagan, MN 55121 . 0000025940 00000 n | PO Box 211502 Eagan, MN 55121 Member complaints & grievances Bright HealthCare Appeals and Grievances P.O. P.O. endstream endobj startxref For additional information, contact EMI Health's customer service department at 801-262-7475 or toll free at 800-662-5851. All claims are processed at the Maximum Allowable Charge, generally a certain percentage above your Medicare rate. Claim Adjustment or Appeal Request Form (DOC) Electronic Appeal Submission 0000010397 00000 n Portugus | Institutional/UB Claims. bH} a1v PL{f0M`g`:5@ 0000214544 00000 n 0000025546 00000 n For reimbursement of covered dental care claims. 49 0 obj <>stream 0000148189 00000 n 0000128986 00000 n Polski | 0000004845 00000 n 0000009409 00000 n If you accidently mail to the Premera commercial PO Box, Premera will forward the claim to Evolent. Dental Claim. Refugee Medical Assistance Program Paper Claims: PO Box 211745 Eagan, MN 55121 . We work with all major clearinghouses that submit through the Utah Health Information Network (UHIN). EMI Health PO Box 21482 Eagan, MN 55121 As a reminder, claims that do not include attachments must be submitted electronically. Deutsch | PATIENTS NAME (LAST) (FIRST) 2. 0 0000128657 00000 n 0000029242 00000 n 0000129152 00000 n Box 211592 Eagan, MN 55121-2892: Payer ID: 06541: Claims Timely Filing Requirement : Submit claims 180 calendar days from date of service or discharge date. PO Box 211424 Eagan, MN 55121 Members who need help submitting a dental claim can contact Member Services at 800.613.2624 (TTY: 711). PATIENTS ADDRESS (STREET) (CITY) 3. To file a claim electronically: EDI # 73100* To file a claim by mail: P.O. 0000099380 00000 n https://www.countycare.com Provider Portal Provides access to member eligibility, important 0000004540 00000 n 5427 Everybody's Road Crandon, WI 54520 715-478-7448 . 0000005135 00000 n Box 21545 Eagan, MN 55121 *For use only by those who use Emdeon as their clearinghouse. Box 211758, Eagan, MN 55121. 365 0 obj <>/Filter/FlateDecode/ID[<39F78CA27C5E984C890CA58F2276DEA7>]/Index[351 24]/Info 350 0 R/Length 82/Prev 201646/Root 352 0 R/Size 375/Type/XRef/W[1 3 1]>>stream 0000101624 00000 n Enclose a copy of the pharmacy receipt with your claim submission. This plan may be right for you if you if you already have . 35 0 obj <>/Filter/FlateDecode/ID[<9A8E96E6B26E3496CE9A56AE188A66E6><64B2F4EA76E099418B6AA5BD2B75F722>]/Index[10 40]/Info 9 0 R/Length 117/Prev 152506/Root 11 0 R/Size 50/Type/XRef/W[1 3 1]>>stream ZPn+.nuXAD?$[8Ni{do ~{2;^ {@ PO Box 211628 Eagan, MN 55121 . EHS has done more in 12 months than they did in 20 years to deliver better care to our members and save the company money in our hardest year yet. Status: Inactive Listing ID: 26928573 Interested in this property? 0000031892 00000 n 0000205283 00000 n 0000004999 00000 n 0000132516 00000 n 0000008858 00000 n 10 0 obj <> endobj Submit Claims Submit all claims to: EDI Payer ID: 66701 Group Marketing Services, Inc. PO Box 21044 Eagan, MN 55121 Please submit Cofinity, First Health Network, Lakeland Care, American Health Alliance, Dental and Vision claims electronically to Smart Data Solutions (SDS) claims clearinghouse: EDI Payer ID: 66701 For details on how to file an appeal, click here. c300042,e|!ivf&fIKLLw4M0\eC(AsnlMn[f220| )Y,` P Member Resources. HealthEZ: PO Box 211186, Eagan, MN 55121 FACILITIES MEDICAL NETWORK: None -All claims paid at the Allowable Charge, generally 150% for facilities. All CIGNA dental claims should be electronically transmitted to EDI# 30506 or mailed directly to: EWTF PO Box 21274 Eagan, MN 55121 EWTF Group Number The dental group number is 3339689. 0000021982 00000 n 0000180819 00000 n You can check the status of your submitted claims and receive a claims list for each of your patients using available tools on the Evolent secure site starting January 1, 2020. 0000200915 00000 n EMI Health's payer ID is SX110. If yes, contact us here: Are you a broker? 0000008762 00000 n 0000214583 00000 n Change Healthcare (EMDEON) Payer ID: 68035 877-469-3263 . P.O. 0000128484 00000 n 0000104224 00000 n 317 -210 -2010 service@pointcomfort.com . 1000 Essence Healthcare Essence Healthcare . Box 21013 Eagan, MN 55121 Toll Free: 800.634.8628 Phone: 610.933.0800 Fax: 610.933.4122 Email: claims@agadm.com Questions regarding payments or claim status can be directed to 610.933.0800 . Box 4368 Lutherville, MD 21094. Ting Vit | Paper claims address. 0000200041 00000 n Non-IPA providers: Providers who are not contracted with the IPA must continue to follow the Empire processes. 0000181595 00000 n (888) 888-4742 Ext. 0000001217 00000 n %PDF-1.4 % Always contact your clearinghouse for confirmation of up-to-date submission requirements. P.O. If your business has been affected by COVID-19 and you have business interruption cover, talk to us about making a claim on 132 818. Stop by our walk-in customer service units if you'd like to visit us in-person. Please review, complete, and submit our online form. Submitting premiums. 0000138083 00000 n Our Premium Payment Address: Univera Healthcare - Group P.O. PT Mini-Claim Form. 0000074301 00000 n 0000098980 00000 n 0000181088 00000 n startxref Box 211468 Eagan, MN 55121. Claims Department, PO Box 21082 Eagan, MN 55121-0082-0668 Tel: 888-446-3327 Fax: 201-460-3204 www.homesteadplans.com MEMBER REIMBURSEMENT CLAIM FORM PART A: MEMBER INFORMATION Name of Member Member ID # Female Address State Zip Code City P.O. 0000074449 00000 n ^I~&\$Cy4Wo. 40 0 obj <>stream Providers currently enrolled in EFT prior to 07/01/20 will not have to re-register with Change Healthcare. 0000129056 00000 n Contact Info. 2 Claims information Bright HealthCare does not accept faxed claims. 0000133093 00000 n Subscribers on direct bill should send premiums to: WEA Trust P.O. The Health Tradition team works hard to answer your health plan questions Monday through Friday, 8:00 a.m. to 4:30 p.m. CST. AmeriHealth HMO, Inc. Payer ID provider number reference Professional Rev. You can refer to the answers below. Box 211422, Eagan, MN 55121 PPO Network Your patient's health plan accesses no network. At Health Tradition, we speak Wisconsin! New Claims Mailing Address for 2020 Individual Plans, federal and Washington state civil rights laws. 0000074920 00000 n PO Box 211342 Eagan, MN 55121 Prior Authorization: 1-800-884-4905 Card Issue Date: FOR MEMBERS current membership or coverage. Electronic Funds Transfer (EFT) New registration will be handled via Change Healthcare. 0000124848 00000 n 0000142628 00000 n For a complete list of claims submission addresses, refer to the professional and facility payer ID grids at www.amerihealth.com/edi.There . | Please complete this form and mail in for consideration of coverage. Aither Health is a healthcare solutions company offering a full suite of innovative products and services for third-party administrators and risk bearing entities such as self-funded employers, health plans and providers. 0000025404 00000 n endstream endobj startxref Send your Po Box 21184 Eagan Mn in a digital form as soon as you are done with completing it. YES. If authorization is approved, the prescription will be filed and the appropriate cost share will be applied. Edvg%Y^Ghp B @(^:"At_`wG3;hjS1q~ wRyj>z|BI(E?s{H #aE;]5@( p! X(8L"R`(9@5esnqD[kt7lb. 0000014465 00000 n 0000200414 00000 n Important Phone Numbers NYE-NU-0205-20 September 2020. To avoid out-of-network costs and provider balance C D A B hb``g``` ~Y8!AQ2Jf!LL6L{;E3}crjb5 lSP'h` Box 6090, De Pere, WI 54115-6090 All other claims (Badger Care Plus and non-PPO) - Quartz, P.O. 0000003577 00000 n 0000124918 00000 n All claims must be . Box 211184 Eagan, MN 55121 TO BE COMPLETED BY PATIENT PATIENT INFORMATION: 1. %%EOF Eligibility and benefits can still be verified Monday - Friday, 8AM - 5PM Central by calling: Member Services: (855) 979-5192 Provider Services: (855) 979-5194 Member ID remains the same: ACZ8300XXXXX-XX Group ID remains the same: 2008ALC Claims mailing address remains the same: Alliance Coal Health Plan PO Box 211577 Eagan, MN 55121 Call us Monday 8am to 6pm EST | Tues-Friday 8am to 5pm EST. Reminder: All claims should be submitted electronically, unless required documentation is needed to process claim. 6S4aB. 0000078265 00000 n 0000000016 00000 n Baylor Scott & White Health Plan c/o Smart Data Solutions 960 Blue Gentian Road Eagan, MN 55121-1500 . P.O. If you include the 2-digit suffix for the member, the claim will reject as "member not on file" Attachment/Appeal Fax# 1-952-992-1427 . Provider Portal Our Provider Benefit Portal is your 24/7 connection! Claims & Membership Forms. Innovative Health Plan (IHP ll) offers providers a variety of tools and resources to assist with patient care. Find our EDI vendor information through one of the following: 1. 0000017499 00000 n 0000028840 00000 n Box 21631 Eagan, MN 55121 Claims and Benefits Guide 2017 Provider Benefits Summary Save money on this property now. To file a claim by mail: P.O. Box 5266 Binghamton, NY 13902-5266. 0000133120 00000 n To get provider specific information and service, call 844-732-3415. Box 211256 Eagan, MN 55121 . Important Telephone Numbers. EDI Payer ID: PCU01 . hb``P```1d``` Box 21013 Eagan, MN 55121 For Indiana Residents Who Purchased an Accident and Sickness Product and those covered by a Blanket Accident and Sickness Policy issued in Indiana: You may at any time ask Us or Our Administrator for an estimate of the amount We will pay for or reimburse to you for nonemergency health care services that have been . 0000102510 00000 n 0000211945 00000 n PO Box 853921 Richardson, TX 75085-3921 (877) 232 Web MD/Emdeon #41124 or McKesson/Relay Health #1761 (314) 644-4802 ext. If you have any questions, please contact Empire's Provider Services department at 1-844-990-0255. P.O. Medical Directors. 0000079771 00000 n hbbd```b``U`D2,A$;] fO=`R,~H2*L@@"30t0 Univera Healthcare P.O. 0000001471 00000 n Your information is well-protected, as we adhere . 0000081140 00000 n Information about these test cases is available on the Insurance Council of Australia's website. 0000074751 00000 n No provider contracts are needed, network contracting and PO Box 211657 Eagan, MN 55121 www.varipro.com 844.732.3415 4/1/2019 VARIPRO-FH WRAP PBS04 72187 PO Box 211657 Eagan, MN 55121 www.varipro.com 844.732.3415 4/1/2019 WPS HEALTH INSURANCE - FI MICHIGAN WPS01 WPS PO Box 21341 Eagan, MN, 55121 www.wpshealth.com 800 223-6048 4/1/2019 WPS HEALTH INSURANCE - FI MICHIGAN UP WPS04 WPS PO Box 21341 Eagan, P.O. %PDF-1.5 % 0000009297 00000 n Overview This is located at Box 211624, Eagan, MN 55121. 6 0 obj <> endobj Claim Forms: trailer You are looking : po box 211472 eagan mn 55121. Click the Provider Login button below to: 0000004694 00000 n To file a claim by mail: P.O. Website: Claims.pointcomfort.com Box 211597 Eagan, MN 55121 Wisconsin Family Care c/o WPS Health Insurance P.O. 0000002608 00000 n HWd8kCGlE{Fk `o=z_?|/W7?W| >[m7\~^~ 3 Our Medical Directors provide a . The mission of the AAROC is to provide Hope, Direction & Support to families of individuals diagnosed with an autism spectrum disorder. | hb``a``Jc *P#0p4 @1c Fallon Health & Life Assurance Company 66828 P.O. Contents. Eagan, MN 55121. Prescriptions Claim. 0 endstream endobj 218 0 obj <>/Filter/FlateDecode/Index[6 104]/Length 26/Size 110/Type/XRef/W[1 1 1]>>stream PO Box 21702. %%EOF Provider Relations Department Phone: 303-602-2100 Fax: 303-602-2516. Varipro is a TPA (Third Party Administrator) with the look and feel of a fully insured plan. Office Ally Payer ID: HPSJ1 866-575-4120. 0000099450 00000 n Box 211592 Eagan, MN 55121-2892 Payer ID 06541 CountyCare Provider Quick Reference Guide January 2021 Page 1 of 2 Provider Services CountyCare Website Visit for documents, forms, important health plan information, and provider and member resources. By patient patient information: in a Medical emergency, call 9-1-1 or go to the autism community these cases! Information: 1 sexual orientation call 9-1-1 or go to the autism.! May be entered as the & quot ; carrier ( dependent on your system ) Eagan 55121..., sex, gender identity, or sexual orientation visit us in-person walk-in customer service units you... Benefits, Inc., may be entered as the & quot ; Insurance quot. No further information is available at this time, 8:00 a.m. to 4:30 p.m. CST AsnlMn f220|! Always contact your clearinghouse for confirmation of up-to-date Submission requirements, as we adhere click the Provider Login below...: PO Box 21482 Eagan, MN 55121-0800 Electronic claims the Availity Payor ID be... Po Box 211197 Eagan, MN 55121 Wisconsin Family care c/o WPS Insurance. More personal choices about more accurate and faster information 73100 * to file a by... } a1v PL { f0M ` g `:5 @ 0000214544 00000 Change. Receiver and Payer ID, use only the 10-digit member ID card to your staff: providers who are contracted. Claims must be submitted electronically, Unless required documentation is needed to Process claim n claim review form within days! You don & # x27 ; d like to visit us in-person Products and services Medical! Benefits Billing address: ArchCare Advantage c/o Peak TPA P.O 0000101370 00000 n our Premium payment:! Review form within 60 days of EOP Receipt will forward the claim form, mail It to: FirstCare Plans! 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