Enter your ZIP code to learn about the CarePlus Medicare Advantage plans in your area, or call us at 1-855-605-6171; TTY: 711.
To enroll in electronic funds transfer (EFT) and electronic remittance advice (ERA), you must complete the EFT/ERA form (PDF opens in new window) and fax the completed form to 1-855-659-7966. You also can mail your completed form to:
CarePlus Health Plans
Attn: Provider Operations
11430 NW 20th St., Suite 300
Miami, FL 33172
Additional information: CarePlus works with Change Healthcare to send ERAs to healthcare providers. Please work with your system vendor or billing service to enroll in ERA for CarePlus Health Plans. To enroll directly with Change Healthcare:
Note: The CarePlus Health Plans payer ID for Change Healthcare is 65031.
If you have questions about the form, call our Provider Operations inquiry line at 1-866-220-5448 (choose Option 1, then 4), Monday – Friday, 8 a.m. – 5 p.m., Eastern time.
Please submit claims for processing in a HIPAA-compliant 837 file format and file them electronically with Availity (link opens in new window) using CarePlus payer ID 95092 (specific to Availity). For 837P only, file with Change Healthcare (link opens in new window) using CarePlus payer ID 65031 (specific to Change Healthcare).
Healthcare providers should work with their practice management system, system vendor or billing service to ensure CarePlus Health Plans is enabled for electronic claim submission. If unable to submit electronically, providers can submit professional claims on a properly completed CMS 1500 form within the time frame specified in their contracts. Providers may use the revised 1500 claim form (version 02/12). This approved, updated 1500 claim form accommodates reporting needs for ICD-10 and aligns with requirements in the Accredited Standards Committee X12 (ASC X12) Health Care Claim: Professional (837P) Version 5010 Technical Report Type 3.
If unable to submit facility claims electronically in 837I file format, providers can submit them on a properly completed UB-04/CMS 1450 form within the time frame specified in their contracts.
If all electronic data interchange (EDI) methods fail, and you’ve already contacted your provider services executive for assistance, mail the paper claim submission and claim-related correspondence to the following address:
CarePlus Health Plans
Attn: Claims Department
P.O. Box 14697
Lexington, KY 40512-4697
Not submitting a clean, properly completed claim will delay processing. CarePlus’ contracted provider filing limitation is 180 days from the date of service or the through-date of service listed on the claim form, whichever is the later date. The non-contracted provider filing limitation is 12 months from the date of service or the through-date of service listed on the claim form, whichever is the later date.
The 837 TR3 (Technical Report Type 3) defines the values submitters must use to signal to payers that the inbound 837 contains a reversal or correction to a claim that was previously submitted for processing. For both professional and institutional 837 claims, the 2300 CLM05-3 (claim frequency code) must contain a value from the National UB Data Element Specification Type List, Type of Bill and Position 3. Values supported for corrections and reversals are:
The following coding must be used:
Segment CLM05-3 = 7
Segment REF01 = F8
Segment REF02 = the 13-digit original claim number - no dashes or spaces
If submitting via paper:
Professional corrected claims or voided claims that have a 7 or 8 in Box 22 should include the original claim number in the ORIGINAL REF NO field. When a 7 code populates in Box 22, the new claim will follow the replacement-of-prior-claim process. When an 8 code populates in Box 22, the new claim will follow the void/cancellation of the prior claim process.
Institutional corrected claims or voided claims that have a 7 or 8 in Box 4 (type of bill) should include the original claim number in Box 80 REMARKS. When the applicable frequency code is populated, the new claim will follow the applicable correction or void process. The number 7 represents replacement of prior claim; the number 8 represents a voiding or cancellation of a prior claim.
For institutional claims only, when the need for a correction is discovered beyond the claim’s timely filing limit of one year, an institutional provider must utilize the reopening process using the new bill-type frequency, submitting with a Q in Box 4 (Type of Bill) to identify it as a reopening. The provider also should include a series of condition codes that can be used to identify the type of reopening being requested. Reopenings for “good cause” must have a remark/note from the provider.*
*Institutional providers can request a reopening for any reason within one year from the date of the original determination or redetermination. Providers also may request a reopening for “good cause” within four years from the date of the original determination or redetermination. Good cause exists when: