BadgerCare Plus & Medicaid SSI Provider Manual - Group Health ...

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BadgerCare Plus & Medicaid SSI Provider Manual - GHC of Eau Claire June 2012 ADMINISTRATIVE CONTACTS Group Health Cooperative of Eau Claire Contacts for Providers Call your Provider Services Department for: Patient Benefits, Coverage or Eligibility Patient Concerns Claims Status Billing & / Or Payment Procedures Medicaid Enrollment, Membership, Eligibility Electronic Billing PROVIDER SERVICES DEPARTMENT 715-552-4333, or toll free 1-866-563-3020 MEMBER SERVICES DEPARTMENT 715- 552-4300, or toll free 1-888-203-7770 Call your Health Management Department for: Prior Authorizations (inpatient admissions, referrals, elective surgery, etc.) Mental Health/AODA Questions or Authorizations HEALTH MANAGEMENT DEPARTMENT 715-552-7200, or toll free 1-800-218-1745 Fax Number: 715-552-7202 Call your Provider Relations Department for: Contractual Arrangements such as fee schedules or reimbursement Changes to your Tax ID, Office Address, additional locations/clinics Provider Log-In Assistance PROVIDER RELATIONS DEPARTMENT 715-552-4300, or toll free 1-888-203-7770 Call your Credentialing Department for: Adding a new practitioner Check on status of a Credentialing Application CREDENTIALING DEPARTMENT 715-552-4300, or toll free 1-888-203-7770 Call our Pharmacy Benefits Manager (PBM) for: Formulary questions PHARMASTAR PBM 715-552-4320, or toll free 1-888-298-7770 Call Quality Improvement Department for: Questions or requests for information on GHC’s Quality Improvement Activities QUALITY IMPROVEMENT MANAGER 715-552-4300, or toll free 1-888-203-7770
BadgerCare Plus & Medicaid SSI Provider Manual - GHC of Eau Claire May 2012 SECTION 1 – CLAIMS INFORMATION CLAIMS SUBMISSION In order to facilitate timely payment of claims submitted to GHC, please utilize the appropriate claim forms and follow standard submission guidelines for your provider type. Submit all claims to: Group Health Cooperative of Eau Claire or Compcare PO Box 3217 Eau Claire, WI 54702-3217 Questions regarding the processing of your claims may be directed to the Provider Services Department at GHC. You can reach Provider Services directly at 1-866-563-3020 (toll-free), or at 715-552-4333. Staff is available Monday-Friday, 8 a.m. to 5 p.m., to answer questions regarding how your claims are processed. We do not issue Providers a special identification number for billing purposes. However, each Member has an unique member identification number. GHC utilizes payment rationale based on various coding sources including but not limited to CPT, HCPCS, ICD-9 and CMS/CCI (Correct Coding Initiative) edits. ELECTRONIC CLAIM SUBMISSION - CLEARINGHOUSES To expedite payment to you, GHC encourages electronic billing whenever possible. GHC works with five clearinghouses: Emdeon (95192), SDS (Smart Data Solutions), Cvikota Company, Relay Health, SSI Group, Inc. In addition, GHC exchanges electronic remittance advice with four clearinghouses: Cvikota, Relay Health, Gateway EDI LLC, and Rycan Technologies, Inc. Since many clearninghouses work together, please check with your clearinghouse if you do not see it listed above. Please note: Providers are not required to utilize a clearinghouse. GHC does not charge claim submissions fees for a direct connection. Clearinghouses may charge a fee. It is the provider's responsibility to discuss these potential fees with the clearinghouse. GHC has a simple one-page form to trade basic information on establishing a direct connect. Please call GHC Provider Services at 1-866-563-3020 to obtain the Electronic Claims Setup form. No paperwork (including this form) is necessary to submit claims through a clearinghouse. In addition, GHC has a setup form available for the following types of electronic transactions: Electronic Remittance Advice form Eligibility Benefit Inquiry and Response form Claims Status Inquiry and Response form Contact GHC Provider Services at 1-866-563-3020 for more information. [7]
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