Provider Quick Reference Guide
| 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. |
[email protected] |
| 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) [email protected] |
| 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) |
| 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. |
[email protected] |
| 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 MedImpact 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 |