Claims Inquiry Phone # Authorization Process. Fee Schedule Notes. Claims Address
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1 Inquiry ADVANTAGE 360 ( Self-funded) Optional Advantage 360 (call # on ID for add'l ( Terming 12/31/2016 ADVANTAGE Health Solutions HMO Prime ProHealth Risk ProHealth ing P.O. Box Indianapolis, IN ProHealth Customer Service (317) or (800) Refer to Provider Directory for list for provider referrals; otherwise, call Med Mgmt for (call # on ID for add'l ( Terming 12/31/2016 Aetna Medicare Advantage PPO Medicare CHI (call # on ID for add'l ( Aetna US Healthcare / PPO / POS / EPO Aetna CHI see website 120 day billing deadline (call # on ID for add'l ( Anthem Healthy Indiana Plan (HIP) Ages Employed Medicaid (call # on ID for add'l Excludes pediatrics Anthem Blue Cross Blue Shield HMO / PCI / PPN Traditional / Blue Anthem 90 day billing deadline (call # on ID for add'l ( 1)Anthem assigns their own effective date which takes up to 120 days. Anthem Medicaid Ages 0-18 Employed Medicaid (call # on ID for add'l
2 Inquiry Anthem Preferred Medicare PPO/HMO Follows Medicare guidelines. (call # on ID for add'l ( 1) Anthem assigns their own effective date. 2) Plan is not currently active in the Anderson area. 3) Plan utilizes Medicare fee schedule (See attachment for fee inquires) Anthem Medicare HMO (call # on ID for add'l ( 1)Anthem assigns their own effective date which takes up to 120 days. Anthem Blue Cross Blue Shield Workers Comp Anthem 90 day billing deadline (call # on ID for add'l ( 1)Anthem assigns their own effective date which takes up to 120 days. Beech Street Basic ProHealth PPO All ProHealth (call # on ID for add'l ( 1) Plan utilizes ProHealth PPO fee schedule (See attachment for fee inquires) Caresource Medicare (call # on ID for add'l Central IN Health Partners Basic ProHealth Risk All ProHealth (call # on ID for add'l CIGNA HMO/PPO/POS- No Mid Levels (No Behavioral Care ) CIGNA & 180 day claims filing limit. (call # on ID for add'l ( No Mid-Levels Cofinity (formerly PPOM) Optional Cofinity CHI Employed. Non (call # on ID for add'l 1) Plan falls under Aetna.
3 Inquiry Health Alliance Health Alliance s & (call # on ID for add'l CorVel Workers Compensation Network Workers Comp. ProHealth Workers Comp. Optional for ALL. One agreement for all 4 plans. (call # on ID for add'l ( Agreement includes Corvel, First Health,USA/MCO and Encore Work Comp Plans. Coventry National / First Health Network Basic ProHealth PPO All ProHealth (call # on ID for add'l ( Acquired by Aetna. encircle EPO Optional Encircle EPO (call # on ID for add'l ( Encore and Encircle effective date will be one month following the ProHealth Effective date. Encore PPO Optional Encore PPO (call # on ID for add'l ( Encore and Encircle effective date will be one month following the ProHealth Effective date. Encore Work Comp Plan Workers Comp. ProHealth Optional for ALL Workers Comp. One agreement for all 4 plans. (call # on ID for add'l ( t includes Corvel, First Health,USA/MCO and Encore Work Comp Plans. First Health / FOCUS Worker's Comp Workers Comp. ProHealth Workers Comp. Optional for ALL. One agreement for all 4 plans. (call # on ID for add'l ( t includes Corvel, First Health,USA/MCO and Encore Work Comp Plans. Fortified Provider Network Optional Fortified Provider Network (Pays 90% of billed charges) (call # on ID for add'l (
4 Inquiry Galaxy Health Network Optional Galaxy Health Network (Pays 85% of billed charges) (call # on ID for add'l 120 day claims filing limit for most GHN payers ( 1) Galaxy fee schedule is 90% billed charges Gold Plan Prime PH Risk (call # on ID for add'l Health Network Employee Benefit Plan HealthNet Tricare (Military) Champus & Access website for specific info. (call # on ID for add'l ( ( & ( 1) HealthNet assigns their own effective date. Humana ChoiceCare Medicare Advantage PPO / Gold Choice PFFS CHI Employed Only. Follows Medicare guidelines. (call # on ID for add'l ( 1) Plan is not currently active in Anderson area. 2) Plan utilizes Medicare fee schedule (See attachment for fee inquires) Humana Gold Plus HMO- Medicare Advantage CHI Employed Only. Follows Medicare guidelines. (call # on ID for add'l ( 1) Plan utilizes Medicare fee schedule (See attachment for fee inquires) IHN IHN & (call # on ID for add'l ( Now owned by CIGNA IU Medicare Plan CHI Employed Only. Follows Medicare guidelines. (call # on ID for add'l Lutheran Preferred Prime ProHealth PPO (call # on ID for add'l (
5 Inquiry MHS (Managed Health Services- Medicaid) HIP and Medicaid Medicaid Medicaid CHA employed PCP's and CHI/CHA/Howard/Westvi ew (call # on ID for add'l INCLUDES All specialists plus:ob/gyn, NP's, Symptom Management Group, Comm Group Clinicians, but EXCLUDES: Behavioral health, PA's, and PCP's MDwise CHN, Hoosier Care Connect, Behaioral Health, HIP and Medicaid Medicaid Medicaid Multiplan Basic ProHealth PPO CHI Employed & Howard all PCP's and All ProHealth Call MDWise Call MDWise Refer to MDwise list for provider referrals; otherwise, call Med Mgmt for authorization 180 day claims filing limit. (call # on ID for add'l (call # on ID for add'l ( Private Healthcare Systems (PHCS) Basic ProHealth PPO l All ProHealth 180 days filing limit. (call # on ID for add'l ( Sagamore Plus PPO/Ambassadore POS Optional Sagamore PPO & POS All ProHealth Prime may opt to participate (call # on ID for add'l ( Secure Horizons / Evercare United Healthcare & se (call # on ID for add'l EverCare is for dually eligible members (Medicare/Medicaid) SIHO Basic ProHealth PPO All ProHealth 90 day filing limit. (call # on ID for add'l ( Silver Plan Prime ProHealth Risk (call # on ID for add'l Health Network Employee Benefit Plan
6 Inquiry Stratose Network (formerly NPPN/Plan Care America) Basic ProHealth PPO All ProHealth (call # on ID for add'l ( Do not enroll Mid-Levels United Healthcare United Healthcare & 90 day claims filing limit. (call # on ID for add'l ( USA MCO Basic ProHealth PPO ProHealth (call # on ID for add'l ( USA MCO & Compensation Workers Comp. ProHealth Optional for ALL Workers Comp. One agreement for all 4 plans. (call # on ID for add'l ( Agreement includes Corvel, First Health,USA/MCO and Encore Work Comp Plans.
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