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.

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
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.

630-403-3210
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

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)

countycarewaivers@cookcountyhhs.org

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 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
P.O. Box 21153
Eagan, MN 55121

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