Provider Quick Reference Guide

For a PDF version of the Provider Quick Reference Guide, please click here.

CountyCare Website

Visit for documents, forms, important health plan information, and provider and member resources.
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

Utilize system to verify Medicaid eligibility. 

Universal Provider Roster

Submit any provider addition, change or terminations monthly and send a complete IAMHP universal roster quarterly.
Member & Provider Services

M- F: 8:00AM – 6:00PM CT
Saturday: 9:00AM – 1:00PM CT

312-864-8200, 711 (TTY/TDD)
Transportation Scheduling

Contact First Transit to request a ride 3 business days prior to member need.

630-873-1440 fax
Fraud, Waste and Abuse Hotline

Use our confidential hotline to report concerns.

Provider Disputes

Submit disputes within 60 calendar days from EOP.
Critical Incidents

Complete a critical incident form.

312-864-8200, 711 (TTY/TDD)

Clearinghouse Vendor

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.
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.
Care Management Referrals for Members in HCBS Waivers 312-864-8200, 711 (TTY/TDD)

Referrals to Care Coordination

Complete the care coordination referral form.
Dental Preauthorization

Request at Provider Portal.

Avesis Portal
Vision Preauthorization

Request at Provider Portal.

Avesis Portal
Pharmacy Preauthorization (including Specialty)

Submit the MedImpact medication request form

858-790-7100 fax
Medical Necessity Appeals

Submit appeals within 30 days of an authorization denial.

CountyCare Health Plan
P.O. Box 21153
Eagan, MN 55121