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Claims Processing

Questions? We've got answers! View the Frequently Asked Questions below. Click each topic for details. 

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  Where can I learn iCare's claims information and mailing addresses?

iCare’s Timely Filing Limit is 120 days from the date of service (DOS) on a CMS 1500 claim form unless otherwise specified in the Provider’s Contract.

iCare’s Timely Filing Limit is 120 days from the Thru date on a UB04 claim form unless otherwise specified in the Provider’s Contract.

New day paper claims submitted with a Primary carrier explanation of benefits (EOB) will be processed as timely as long as the EOB has been submitted within 90 days of the Primary carrier’s EOB date.

  • iCare Medicare and Medicaid Plans

Independent Care Health Plan

P.O. Box 660346

Dallas, TX 75266-0346

  • iCare Family Care Partnership Long Term Care Services*

Independent Care Health Plan

P.O. Box 224255

Dallas, TX 75222-4255

*Members in the Family Care Partnership program are entitled to benefits beyond the benefits available to Medicare Advantage and Medicaid SSI members. A list of these LONG TERM CARE services can be found in the iCare Family Care Partnership section of this site.

  How and where do I submit corrected claims information?

Providers have 60 days from the original iCare explanation of payment (EOP) date to submit a corrected claim.
Note: If the original iCare claim denies for the Primary EOB, the provider has to submit a paper corrected claim with the itemized Primary EOB within 60 days of the original iCare EOP date.

Corrected Claims can be submitted by using one of the following methods:

  • Paper claim submission with “Corrected Claim” stamped or written on the claim
  • CMS 1500 paper claim form with Box 22 indicating 7 (replacement of prior claim)
  • UB04 paper claim form with last digit of bill type indicating 7 (117, 137, etc.)
  • Professional and Facility corrected claims can also be submitted electronically by following the 5010 standards for electronic claims submission – the provider’s clearinghouse will be aware of these requirements.
    Note: “Corrected Claim” stamped or written on the claim or the original claim number does not need to be included on a paper or an electronic claim as long the required 7 is in box 22 of the CMS 1500 claim form or the required bill type ending in 7 is on the UB04 claim form.
  • iCare Medicare and Medicaid Plans

Independent Care Health Plan

P.O. Box 660346

Dallas, TX 75266-0346

ATTN: Operations Department

  • iCare Family Care Partnership Long Term Care Services*

Independent Care Health Plan

P.O. Box 224255

Dallas, TX 75222-4255

ATTN: Operations Department

*Members in the Family Care Partnership program are entitled to benefits beyond the benefits available to Medicare Advantage and Medicaid SSI members.
A list of these LONG TERM CARE services can be found in the iCare Family Care Partnership section of this site.

  How are Claims errors handled?
Adjustment Process

iCare strives to process submitted claims in a timely and accurate manner. Quality is a top priority. However, when claims processing and submission errors do occur, iCare's goal is to accurately resolve the situation as quickly as possible. iCare is introducing a new process for Review/Reopening and Reconsideration/Formal Appeal process. This new process will ensure that provider’s disputes are handled in a fast, fair and cost-effective manner.

Review/Reopening

Review/Reopening is the first level request to review a processed claim when the provider does not agree with the outcome and feels the claim warrants an adjustment. Providers should complete the Review/Reopening form and attach any supporting documentation relevant to the request. Review/Reopening requests can also be made telephonically by calling Customer Service or can be mailed to the address below within 60 days from the date of the EOP:

  • Review/Reopening Form Address
  • P.O. Box 660346
  • Dallas, TX 75266-0346

Effective 4/1/2017 Review/Reopening forms will be required, so please begin using immediately to avoid processing delays.

Reconsideration/Formal Appeal

Reconsideration/Formal Appeal is a formal process to review a processed claim when the provider does not agree with the outcome and feels the claim warrants an adjustment. The provider must submit this request in writing. Providers are not required to first submit a review/reopening request, but are encouraged to do so for minimal processing errors. Providers should complete the Reconsideration/Formal Appeal form and attach supporting documentation; including the required Waiver of Liability (WOL) form. Request cannot be handled telephonically and should be mailed to iCare Appeal Department Address below within 60 days from the date of the EOP or response to the review/reopening request:

Reconsideration/Formal Appeal Form Address:

iCare Appeal Department

1555 N. RiverCenter Dr., Suite 206

Milwaukee, WI 53212

Effective 4/1/2017 Review/Reopening forms will be required, so please begin using immediately to avoid processing delays.

  Where can I find Remittance Advice Reason Codes & Narratives?

iCare has provided reason codes and narratives for the remittance advice in a convenient location below.
iCare Remit Reason Codes.

  How do I submit Complete & Clean Claims?
  Are there claims filing limits?

Effective with dates of service 01/01/2017 and after the timely filing limits for all providers is 120 days from the date of service, unless otherwise agreed upon and included in the Provider’s service agreement with iCare.

Dates of service prior to 01/01/2017 will still be subject to the 60-day timely filing limit that was in place at that time, unless otherwise agreed upon and included in the Provider Services agreement with iCare.

Providers are to submit all claims for services rendered where an iCare Medicare plan is primary or iCare Medicaid is primary according to the terms of the contract.

120-day timely filing limits applies to initial claim submissions. Timely filing for resubmissions and corrected claims is 60 days from the date of the EOP.

  Have questions on your EOP or need an additional EOP?

Providers receive an Explanation of Payment (EOP) including each claim submitted to iCare.  This document was developed to assist you in understanding the EOP. Please note: iCare charges a $25.00 fee for additional EOPs. 
Provider can also obtain a copy of their EOP from the Provider Portal.

Remittance Education Package

Direct questions regarding the EOP to iCare's Provider Services:

  How can I submit claims electronically?

Note: Does not apply to LTC providers” (LTC Providers should see How can I submit Long Term Care (LTC) Claims. )

To register with Claimsnet.com for electronic claims submission via the internet, visit the following URL and click “Register:”
http://www.claimsnet.com/icare

The Payer Code for iCare is 11695. This code is required when you contact the clearinghouse or other entities that have been chosen to transmit your claims electronically.

To learn more about Electronic Claim Submission, Electronic Remittance, Payment Methodology and Coordination of Benefits, visit iCare's Claims Overview page

  How can I submit Long Term Care (LTC) Claims?

Professional LTC claims can be submitted via iCare’s professional services claim form by mail or use the Provider Portal

Residential LTC claims can only be submitted via iCare’s residential claim form by mail

  How can I receive electronic remittance?

If you would like to receive electronic remittance, simply complete the brief Electronic Remittance Advice (ERA) enrollment form.  A representative of iCare will contact you.

  How does iCare handle Coordination of Benefits?

Coordination of Benefits (COB) is necessary when a member is covered by more than one insurance carrier. With few exceptions, iCare Medicaid is the payer of last resort in most COB circumstances. In order to process a claim when iCare is not the primary carrier, a complete Explanation of Benefits (EOB) from the primary insurer, including the Medicare EOB (MEOB), must accompany a copy of the original claim. If the member has both iCare Medicare and iCare Medicaid submit the original claim with the iCare Medicare identification number then both the iCare Medicare and iCare Medicaid claims process. A Medicare EOB is not needed. Refer to the iCare Provider Reference Manual or the iCare FCP Provider Reference Manual for more information.

  Does iCare offer Electronic Claims Submission and Remittance?

Yes! iCare is pleased to partner with one of the nation’s leading claims submission provider, Claimsnet.com, to allow electronic claims submission. Save time and reduce costs as you increase office productivity and eliminate costly delays in reimbursement.

To register with Claimsnet.com for electronic claims submission via the internet, visit ClaimsNet.com and click on “Register”. You will be able to use the iCare section of the Claimsnet website to avoid paying any set-up or submission fees for submitting your iCare claims through Claimsnet.

iCare's payer ID code is 11695. Enrollment can be done online and you can immediately take advantage of our on-line claims submission, real-time error reporting and payor updates.

Electronic Remittance (835)

If you would like to receive electronic remittance, please complete and submit the Electronic Remittance Advice (ERA) enrollment form online. 

An iCare representative will contact you to complete the process.

Leaving iCareHealthPlan.org

By clicking this link, you may be leaving the iCareHealthPlan.org website. Independent Care Health Plan (iCare) only provides these links and pointers for your information and convenience. When you select a link to an outside website, you are leaving the www.iCareHealthPlan.org website.

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