Claims and Electronic Transactions
CountyCare has partnered with Evolent 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.
Providers have the right to request a review of any claim decision made by CountyCare. The appeal process affords the provider the opportunity to refute a denial of payment, or provide corrected information to the original request. Provider claim appeals may be submitted for any of the following denial reasons: timely filing, review of contract rate/ payment, duplicate claim, authorization, or other unforeseen reason.
All requests for claim or medical necessity reviews must be received within 60 calendar days from the date of the Explanation of Payment (EOP) or Remittance Notice. All review types will be researched, and CountyCare will provide a substantive response intended to resolve the dispute after receipt of the request.
Claim Reviews may now submitted via the Provider Portal or by mail. Please complete the Provider Claim Review Form and visit CountyCare Provider Portal home page for more information and training materials.
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.
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. CountyCare Health Plan has joined the InstaMed Network to deliver your payments via free electronic remittance advice (ERA) and electronic funds transfer (EFT). To receive CountyCare Health Plan payments as free ERA/EFT, register at www.instamed.com/eraeft by January 19, 2018.
ERA/EFT is a convenient, paperless and secure way to receive claim payments. Funds are deposited directly into your designated bank account and include the TRN Reassociation Trace Number, in accordance with CAQH CORE Phase III Operating Rules for HIPAA standard transactions. Additional benefits include:
- Accelerated access to funds with direct deposit into your existing bank account
- Reduced administrative costs by eliminating paper checks and remittances
- No disruption to your current workflow – there is an option to have ERAs routed to your existing clearinghouse
You have two simple options to register for free ERA/EFT from InstaMed:
- Online: visit www.instamed.com/eraeft
- Paper: complete the enclosed order form and fax it to (877) 755-3392
Please do not hesitate to contact us directly at (866) 945-7990 or firstname.lastname@example.org with any questions about this free solution. 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 Health Plan
P.O. Box 211592
Eagan, MN 55121-2892