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
iCare Health Plan
P.O. Box 660346
Dallas, TX 75266-0346
iCare Family Care Partnership Long Term Care Services*
iCare 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
Only claims that are complete will be accepted.
The forms providers should use are below.
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 (unless otherwise specified in the provider contract).
Note: If the original iCare claim denies for the Primary EOB, the provider must submit a hardcopy 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 ALL original 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 as follows:
- Paper claim submission with “Corrected Claim” stamped/written on the claim or include:
- CMS 1500 claim form
- Box 22 – Resubmission Code, 7 (replacement of prior claim) and Original Ref No. (iCare Claim number)
- UB04 claim form
- last digit of bill type indicating 7 (117, 137, etc.)
- Include Document Control Number in Box 64 (iCare claim number)
- Changing a claim from Inpatient to Outpatient would be a “Corrected Claim” not a New Claim
- Electronic Professional and Facility corrected claims can also be submitted by following the 5010 standards for electronic claims submission – the provider’s clearinghouse will be aware of these requirements.
Submit Corrected Claims To:
iCare Medicare and Medicaid Plans
iCare Health Plan
P.O. Box 660346
Dallas, TX 75266-0346
ATTN: Operations Department
iCare Family Care Partnership Long Term Care Services*
iCare 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:
- Monday through Friday, 8:00-5:00
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:
iCare Health Plan
Review/Reopen
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 Health Plan
Appeal Department
1555 N. RiverCenter Dr., Suite 206
Milwaukee, WI 53212
If a provider is not satisfied with iCare’s response to an appeal, or if iCare does not respond to the provider within the required timeframe, the provider may appeal to DHS. Providers are required to first exhaust all appeal rights with iCare before appealing to DHS. All Appeals to DHS must be submitted in writing to DHS within sixty (60) calendar days of iCare’s final decision or failure to respond to the provider, as follows:
BadgerCare Plus and Medicaid SSI
Managed Care Unit – Provider Appeal
P.O. Box 6470
Madison, WI 53716-0470
Fax Number: 608 224-6318
Vision Claims Processing
- Optometry claims should be submitted to NVA
National Vision Administrators, LLC
1-888-287-0116
www.e-nva.com
Mailing Address:
P.O. Box 2187
Clifton, NJ 07015
- Ophthalmology claims should be submitted to iCare
Mailing Address:
iCare Medicare and Medicaid Plans
iCare Health Plan
P.O. Box 660346
Dallas, TX 75266-0346
Vision Claims Overview: https://www.icarehealthplan.org/Files/Resources/PROVIDER-DOCS/VisionClaimsGuideline2020.pdf