[vc_row us_bg_image_source=”featured” us_bg_overlay_color=”_alt_content_overlay” css=”%7B%22default%22%3A%7B%22min-height%22%3A%22500px%22%2C%22margin-left%22%3A%2250px%22%2C%22margin-bottom%22%3A%2250px%22%2C%22margin-right%22%3A%2250px%22%2C%22padding-left%22%3A%220%22%2C%22padding-top%22%3A%220%22%2C%22padding-bottom%22%3A%220%22%2C%22padding-right%22%3A%220%22%7D%2C%22tablets%22%3A%7B%22min-height%22%3A%22400px%22%2C%22margin-left%22%3A%221rem%22%2C%22margin-bottom%22%3A%2250px%22%2C%22margin-right%22%3A%221rem%22%2C%22padding-left%22%3A%220%22%2C%22padding-top%22%3A%220%22%2C%22padding-bottom%22%3A%220%22%2C%22padding-right%22%3A%220%22%7D%2C%22mobiles%22%3A%7B%22min-height%22%3A%22300px%22%2C%22margin-bottom%22%3A%2250px%22%2C%22padding-left%22%3A%220%22%2C%22padding-top%22%3A%220%22%2C%22padding-bottom%22%3A%220%22%2C%22padding-right%22%3A%220%22%7D%7D”][vc_column][vc_row_inner css=”%7B%22default%22%3A%7B%22padding-top%22%3A%223rem%22%2C%22padding-bottom%22%3A%223rem%22%7D%7D”][vc_column_inner][vc_custom_heading text=”Provider Quick Reference Guide” font_container=”tag:h1|text_align:center” use_theme_fonts=”yes”][/vc_column_inner][/vc_row_inner][vc_row_inner][vc_column_inner width=”1/6″][/vc_column_inner][vc_column_inner css=”%7B%22default%22%3A%7B%22background-color%22%3A%22%23ffffff%22%2C%22margin-bottom%22%3A%22-100px%22%2C%22padding-left%22%3A%223.5rem%22%2C%22padding-top%22%3A%223.5rem%22%2C%22padding-bottom%22%3A%223.5rem%22%2C%22padding-right%22%3A%223.5rem%22%2C%22box-shadow-v-offset%22%3A%222px%22%2C%22box-shadow-blur%22%3A%2215px%22%2C%22box-shadow-spread%22%3A%220%22%2C%22box-shadow-color%22%3A%22rgba%2861%2C66%2C70%2C0.30%29%22%7D%2C%22tablets%22%3A%7B%22margin-left%22%3A%222.5rem%22%2C%22margin-bottom%22%3A%22-100px%22%2C%22margin-right%22%3A%222.5rem%22%2C%22padding-left%22%3A%223.5rem%22%2C%22padding-top%22%3A%223.5rem%22%2C%22padding-bottom%22%3A%223.5rem%22%2C%22padding-right%22%3A%223.5rem%22%7D%2C%22mobiles%22%3A%7B%22margin-left%22%3A%222rem%22%2C%22margin-bottom%22%3A%22-100px%22%2C%22margin-right%22%3A%222rem%22%2C%22padding-left%22%3A%221.5rem%22%2C%22padding-top%22%3A%221.5rem%22%2C%22padding-bottom%22%3A%221.5rem%22%2C%22padding-right%22%3A%221.5rem%22%7D%7D” width=”2/3″][vc_column_text]
For a PDF version of the Provider Quick Reference Guide, please click here.
[/vc_column_text][/vc_column_inner][vc_column_inner width=”1/6″][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column][vc_tta_accordion][vc_tta_section title=”Provider Services” tab_id=”1609434002045-5b37c751-0e9c”][vc_column_text css=”%7B%22default%22%3A%7B%22padding-top%22%3A%220%22%2C%22padding-bottom%22%3A%220%22%7D%7D”]
| CountyCare Website Visit for documents, forms, important health plan information, and provider and member resources. | www.countycare.com |
| Provider Portal Provides access to member eligibility, important documents, forms, authorization submission and status, claim status, claim review requests, and panel rosters. | Provider Portal Login |
| HFS MEDI System Utilize system to verify Medicaid eligibility. | HFS MEDI Home |
| Universal Provider Roster Submit any provider addition, change or terminations monthly and send a complete IAMHP universal roster quarterly. | CountyCareProviderRosterSubmission@cookcountyhhs.org |
| Member & Provider Services M- F: 8:00AM – 6:00PM CT | 312-864-8200, 711 (TTY/TDD) |
| Transportation Scheduling Contact First Transit to request a ride 3 business days prior to member need. | 630-403-3210 630-873-1440 fax |
| Fraud, Waste and Abuse Hotline Use our confidential hotline to report concerns. | 844-509-4669 |
| Provider Disputes Submit disputes within 60 calendar days from EOP. | www.countycareproviderdispute.jira.evolenthealth.com |
| Critical Incidents Complete a critical incident form. | 312-864-8200, 711 (TTY/TDD) countycarequalityofcare@cookcountyhhs.org |
[/vc_column_text][/vc_tta_section][vc_tta_section title=”Claims (Medical and Behavioral Health)” tab_id=”1609434002083-714774e2-2749″][vc_column_text css=”%7B%22default%22%3A%7B%22padding-top%22%3A%220%22%2C%22padding-bottom%22%3A%220%22%7D%7D”]
| Clearinghouse Vendor Availity | availity.com |
| Paper Claims Mailing Address
| CountyCare Health Plan P.O. Box 211592 Eagan, MN 55121-2892 |
| Payer ID | 06541 |
| Claims Timely Filing Requirement
| Submit claims 180 calendar days from date of service or discharge date. |
| Claim Review Process Complete a claim review form within 60 days of EOP receipt. | www.countycare.valence.care 312-864-8200, 711 (TTY/TDD) |
[/vc_column_text][/vc_tta_section][vc_tta_section title=”Medical Management” tab_id=”1609434018592-821b0f35-5347″][vc_column_text css=”%7B%22default%22%3A%7B%22padding-top%22%3A%220%22%2C%22padding-bottom%22%3A%220%22%7D%7D”]
| Inpatient Admissions Contact Member Services within 24 hours of patient admission. | 312-864-8200, 711 (TTY/TDD) 866-209-3703 fax |
| Prior Authorization Look- up Tool Use the look-up tool to determine if an authorization is required. | Prior Authorization Look-up Tool |
| Prior Authorization Requests Medical and Behavioral Health Complete inpatient or outpatient authorization request form. | www.countycare.valence.care |
| Care Management Referrals for Members in HCBS Waivers | 312-864-8200, 711 (TTY/TDD) |
| Referrals to Care Coordination Complete the care coordination referral form. | countycarereferrals@cookcountyhhs.org |
| Dental Preauthorization Request at Avesis.com Provider Portal. | Avesis Portal 855-337-1594 |
| Vision Preauthorization Request at Avesis.com Provider Portal. | Avesis Portal 855-337-1596 |
| Pharmacy Preauthorization (including Specialty) Submit the CVS Caremark medication request form. | 800-788-2949 858-790-7100 fax |
| Medical Necessity Appeals Submit appeals within 30 days of an authorization denial. | www.countycare.valence.care CountyCare Health Plan |
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