The Centers for Medicare and Medicaid Services (CMS) developed claim forms that record the information needed to process and generate provider reimbursement. This document summarizes the required elements that must be complete, legible and accurate to be handled as a clean claim.

Plans

Clean Claim Requirements (UB-04)

The UB-04 form captures essential data elements as defined by the National Uniform Bill Committee for providers of services in institutional/inpatient/facility settings. This document summarizes the required elements that must be complete, legible and accurate to be a clean claim.

Plans

COVID 19 Claims & Coverage Guide

COVID 19 Webinar for Providers to understand iCare's Prior Authorization guidelines related to COVID claims

Durable Medical Equipment/Supplies (DME/DMS) Claims

EFT Enrollment Check List

Checklist for for Providers for a Successful InstaMed ERA/EFT Enrollment

Hearing Claims

A guide to Hearing Claims

Home Health Claims

A guide to Home Health Claims

Hospice Claims

A guide to Hospice Claims

How To_LTC Professional Claim submission via SSI Claimsnet

A how to for LTC Professionals: Submit a claim via SSI Claimsnet using CSV file

iCare Provider Portal User Guide

iCare’s Provider Portal allows you to bill your Long Term Care Professional claims, view service authorizations and view claim information for the iCare members you serve using your personal computer, cell phone or tablet

iCare Remit Reason Codes

Remittance Reason Codes provide additional explanation for a claim

Plans

ICD10 FAQs

The new classification system provides significant improvements through greater detailed information and the ability to expand to capture additional advancements in clinical medicine.

ICD10 Links

Links to resources to help understand ICD10 claims updates

InstaMed Order Form - Payer Payments

Instamed Order Form - Payer Payments for Providers who do not have an National Provider Identifier (NPI) should submit this Instamed Order Form – Payer Payments form.

Long Term Care (LTC) Claims

A guide to Long Term Care (LTC) Claims

Mental/Behavioral Health & AODA Claims Guide

A guide to Mental/Behavioral Health & AODA Claims

PCW vs. LTC Guide

Personal Care Worker (PCW) Claims

A guide to Personal Care Worker (PCW) Claims

Portal Access Request Form

iCare's Provider Portal allows you to view service authorizations and view claim information for the iCare's members you serve. You can request a PIN number by emailing the completed Portal Access Request Form to netdev@iCareHealthPlan.org

Prior Auth Specific Listing Updated 10.28.19

This document provides specific codes that require a prior authorization. Presence of a code does not guarantee coverage. All referrals for second and third (or additional) opinions, as well as out of state providers require prior authorization.

Reconsideration-Formal Appeal Form

Providers use this form to appeal or dispute a claim denial or claim payment amount.

Remittance Advice Guide

A provider or biller uses this guide to post payments and review claim adjustments. It contains specific claim decision information, includes adjustment reasons and codes and allows for review of denied, paid, overpaid or underpaid claims.

Review/Reopening Form - updated 11/2023

A provider uses this form to dispute a claim denial or claim amount.

SNF Claim Processing Guidelines

Skilled Nursing Facility Claims Guide

Status Check Request Form

The Status Check Request Form is a form for providers to fill out to request information about a claim.

Taxonomy Code Requirements

This communication is in response to questions brought to our attention regarding claim submission requirements for iCare Medicaid claims.

Therapy Services Claims

Therapy Services Claims Processing Guideline

Vision Claims

Vision Claims Guideline