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  Address Update or Add / Remove Provider

Contracted providers wanting to modify their demographic information can request this by filling out the applicable form below:

Name, tax ID, physical or billing address changes
Demographic Change Form

Adding or removing providers associated with a contracted provider group
Affiliation Change Form

 

  Claims Filing Limits

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.

  Claims Mailing Address
  • 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.

  Clean Claim Requirements
  Coordination of Benefits Process

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.

  Corrected Claim 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 must be marked as “corrected claim” and include ALL the line items from the original claim submitted. If line items are not included in the corrected claim, it is assumed that deletion of the line item is part of the correction.

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.

  Electronic Claims Submission

Note: Does not apply to LTC providers. (LTC Providers should see LTC Claim Submission.)

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

To register with SSI Claimsnet for electronic claims submission via the Internet, click here. Select iCare in the payer drop down box on the registration form to avoid paying any set-up or submission fees for your iCare claims through SSI Claimsnet.

Providers who do not have an NPI, please enter 9999999999 in the *required field

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

Please submit questions to Helpdesk_Dallas@ssigroup.com or call 800-356-0092.

The secondary claim can also be submitted with the appropriate loops and segments for the other coverage payment amounts.

Information on the loops and segments for electronic filing of secondary claims can be found here.

  Electronic Funds Transfer (EFT) Enrollment

iCare has joined the InstaMed Network to deliver your payments as free electronic remittance advice (ERA) and electronic funds transfer (EFT) in the near future.

Sign up now to receive iCare payments as direct deposits!

ERA/EFT is a convenient, paperless and secure way to receive claims payments. Funds are deposited directly into your designated bank account and include the TRN Reassociation Trace Number in accordance with CAQH CORE Phase III Operating Rules for HIPAA standard transactions. Additional benefits include:

  • Accelerated access to funds with direct deposit into your existing bank account
  • Reduced administrative costs by eliminating paper checks and remittances
  • No disruption to your current workflow — ERAs can also be routed to your existing clearinghouse

You have two simple options to register for free ERA/EFT from InstaMed:

Providers who do not have a National Provider Identifier (NPI) should submit the Order Form – Payer Payments.  Write “Provider does NOT have an NPI” and attach a copy of your most recent explanation of payment (EOP).  Fax the form and supporting document/s to (877) 755-3392.

For tips on successful EFT enrollment, please see the check list.

  Electronic Remittance / 835 Transaction Enrollment

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

  Explanation of Payment Requests / Copies

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:

  LTC Claim Submission

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

  Remittance Advice Reason Codes

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

  Review / Reopen or Reconsideration / Appeal Process
Appeal 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. In order to avoid processing delays, 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

NOTE: Any Medicaid claims related to a Family Care Partnership member may not utilize the review/reopening request. These requests will need to be submitted as a corrected claim or a formal appeal.

 

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

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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