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Claims and Electronic Transactions

CountyCare has partnered with Valence Health to process claims. Below we provide a brief overview of how to submit a claim for services provided to CountyCare members. For detailed information on claims submission and adjudication, please see the Provider Manual.

Claims eligible for payment must meet the following requirements:

  • The member is effective on the date of service
  • The service provided is a covered benefit under the member’s contract on the date of service, and
  • Referral and prior authorization processes were followed, if applicable

Providers must submit all claims and encounters within 180 calendar days of the date of service. The filing limit may be extended where the eligibility has been retroactively received by CountyCare up to a maximum of 180 days. When CountyCare is the secondary payer, claims must be received within 180 calendar days of the final determination of the primary payer. All claim requests for reconsideration, corrected claims or claim disputes must be received within 45 calendar days from the date of notification of payment or denial is issued.

Electronic Claims Submission

Network providers are encouraged to participate in CountyCare’s electronic claims/encounter filing program. You or your billing agent will need to utilize a third-party claims clearinghouse vendor to submit electronic claims. CountyCare can receive ANSI X12N 837, or most current version, professional, institution or encounter transactions. In addition, it can generate an ANSI X12N 835, or most current version electronic remittance advice known as an Explanation of Payment (EOP).

Providers that bill electronically have the same timely filing requirements as providers filing paper claims. In addition, providers that bill electronically must monitor their error reports and evidence of payments to ensure all submitted claims and encounters appear on the reports. Providers are responsible for correcting any errors and resubmitting the affiliated claims and encounters.

CountyCare’s Payor ID is: 06541.

Our Clearinghouse Vendor is Change Healthcare (formerly known as Emdeon).

Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA)

Electronic Funds Transfer (EFT)

CountyCare provides Electronic Funds Transfer (EFT) to its participating providers. Using EFT helps reduce costs and can improve cash flow. To enroll, providers should review the EFT Enrollment Instructions and complete/return the EFT Enrollment Form per the guidance provided as soon as possible.

For more information on our EFT services, please contact CountyCare Provider Services at 312-864-8200 / 855-444-1661.

Electronic Remittance Advice (ERA)

CountyCare also provides Electronic Remittance Advice (ERA) to its participating providers. Using ERA helps reduce costs and speeds secondary billings. For the initial ERA enrollment set-up with Change Healthcare, please contact Change Healthcare directly. If you currently work with a different clearinghouse for your Electronic Claims Submission, your clearinghouse would work directly with Change Healthcare to set up ERA. You can access the ERA enrollment form by clicking here.

If you or your clearinghouse have any questions regarding the ERA enrollment process or form completion, please contact Change Healthcare Provider Support at 1-877-363-3666 and follow the appropriate prompts.

Paper Claims Submission

For CountyCare members, all claims and encounters should be submitted to:

CountyCare
Attention: CLAIMS
PO Box 3727
Corpus Christi, Texas 78463

  

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