Claims Processing

Claims Processing

  • Claim Mailing Addresses
    • iCare Medicare and Medicaid Plans
      • Independent Care Health Plan
      • P.O. Box 660346
      • Dallas, TX 75266-0346
    • iCare Family Care Partnership Long Term Care Services*
      • Independent Care Health Plan
      • P.O. Box 224255
      • Dallas, TX 75222-4255
    *Members in the Family Care Partnership program are entitled to benefits beyond the benefits available to Medicare Advantage and Medicaid SSI members. A list of these LONG TERM CARE services can be found here.
  • Corrected Claim Mailing Addresses

    Corrected claims must be marked as "Corrected Claim" and include all the line items from the original claim submitted. If line items are not included in the corrected claim, it is assumed that deletion of the line item is part of the correction.

    • iCare Medicare and Medicaid Plans
      • Independent Care Health Plan
      • P.O. Box 660346
      • Dallas, TX 75266-0346
      • ATTN: Operations Department
    • iCare Family Care Partnership Long Term Care Services*
      • Independent Care Health Plan
      • P.O. Box 224255
      • Dallas, TX 75222-4255
      • ATTN: Operations Department

    *Members in the Family Care Partnership program are entitled to benefits beyond the benefits available to Medicare Advantage and Medicaid SSI members. A list of these LONG TERM CARE services can be found here.

  • Claim Errors: Review/Reopening And Reconsideration/Appeals
    Adjustment Process

    iCare strives to process submitted claims in a timely and accurate manner. Quality is a top priority. However, when claims processing and submission errors do occur, iCare's goal is to accurately resolve the situation as quickly as possible. iCare is introducing a new process for Review/Reopening and Reconsideration/Formal Appeal process. This new process will ensure that provider’s disputes are handled in a fast, fair and cost-effective manner.

    Review/Reopening

    Review/Reopening: is the first level request to review a processed claim when the provider does not agree with the outcome and feels the claim warrants an adjustment. Providers should complete the Review/Reopening form and attach any supporting documentation relevant to the request. Review/Reopening requests can also be made telephonically by calling Customer Service or can be mailed to the address below within 60 days from the date of the EOP:

    • Review/Reopening Form Address
    • P.O. Box 660346
    • Dallas, TX 75266-0346

    Effective 4/1/2017 Review/Reopening forms will be required, so please begin using immediately to avoid processing delays.

    Reconsideration/Formal Appeal

    Reconsideration/Formal Appeal: is a formal process to review a processed claim when the provider does not agree with the outcome and feels the claim warrants an adjustment. The provider must submit this request in writing. Providers are not required to first submit a review/reopening request, but are encouraged to do so for minimal processing errors. Providers should complete the Reconsideration/Formal Appeal form and attach supporting documentation; including the required Waiver of Liability (WOL) form. Request cannot be handled telephonically and should be mailed to iCare Appeal Department Address below within 60 days from the date of the EOP or response to the review/reopening request:

    • Reconsideration/Formal Appeal Form Address
      • iCare Appeal Department
      • 1555 N. RiverCenter Dr., Suite 206
      • Milwaukee, WI 53212

    Effective 4/1/2017 Review/Reopening forms will be required, so please begin using immediately to avoid processing delays.

  • Remittance Advice Reason Codes And Narratives

    iCare has provided reason codes and narratives for the remittance advice in a convenient location below.
    Remit Reason codes.

  • Complete And Clean Claims
  • Claims Filing Limits

    Effective with dates of service 01/01/2017 and after the timely filing limits for all providers is 120 days from the date of service, unless otherwise agreed upon and included in the Provider’s service agreement with iCare.

    Dates of service prior to 01/01/2017 will still be subject to the 60-day timely filing limit that was in place at that time, unless otherwise agreed upon and included in the Provider Services agreement with iCare.

    Providers are to submit all claims for services rendered where an iCare Medicare plan is primary or iCare Medicaid is primary according to the terms of the contract.

    120-day timely filing limits applies to initial claim submissions. Timely filing for resubmissions and corrected claims is 60 days from the date of the EOP.

  • Electronic Claims Submission

    To register with Claimsnet.com for electronic claims submission via the internet, visit the following URL and click “Register:”
    http://www.claimsnet.com/icare

    The Payer Code for iCare is 11695. This code is required when you contact the clearinghouse or other entities that have been chosen to transmit your claims electronically.

  • Electronic Remittance (835)

    If you would like to receive electronic remittance, please email your request to . Please include your entity name, contact name, email and phone contact information, your NPI and Tax ID numbers and Name of Clearinghouse. A representative of iCare will contact you.

  • Explanation of Payment/Remittance

    Providers receive an Explanation of Payment (EOP) including each claim submitted to iCare.  This document was developed to assist you in understanding the EOP. Please note: iCare charges a $25.00 fee for additional EOPs.

    Remittance Education Package

    Direct questions regarding the EOP to iCare's Provider Services:

  • Coordination of Benefits

    Coordination of Benefits (COB) is necessary when a member is covered by more than one insurance carrier. With few exceptions, iCare Medicaid is the payer of last resort in most COB circumstances. In order to process a claim when iCare is not the primary carrier, a complete Explanation of Benefits (EOB) from the primary insurer, including the Medicare EOB (MEOB), must accompany a copy of the original claim. If the member has both iCare Medicare and iCare Medicaid submit the original claim with the iCare Medicare identification number then both the iCare Medicare and iCare Medicaid claims process. A Medicare EOB is not needed. Refer to the iCare Provider Reference Manual for more information.

Modified: 8/9/2017
 

  • H2237_IC1453 Approved
 
  • Independent Care Health Plan
  • 1555 RiverCenter Drive, Suite 206
  • Milwaukee, WI 53212
  • Customer Service: 1-800-777-4376
    • 24 hours-a-day, 7 days-a-week
    • (Office Hours: Monday-Friday, 8:30 a.m. to 5:00 p.m.)
  • TTY: 1-800-947-3529
  • Fax: 414-231-1092
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