Provider Claims Tools
The Basics of Navigating Coordinated Care Claims and Payment
The Coordinated Care Claims and Payment Decision Tree can help guide you through some common claims and payment-related issues. Within this document, you’ll find the steps you’ll need to take if:
- Your claim was denied
- You are awaiting payment for a submitted claim
- You have a question about how your claim processed
- You’ve noticed a concerning trend in your claim denials/payments
- You want a progress update on an existing claim issue
Download a copy of the Claims and Payment Decision Tree (PDF)
Claims Reconsiderations and Disputes
A Request for Reconsideration (Level I) is a communication from a provider about a disagreement with the manner in which a claim was processed. A Reconsideration can be submitted to Coordinated Care via the Provider Portal, or by mailing a completed Reconsideration and Dispute form to the address listed on the form. A Claim Dispute (Level II) should be used only when a provider has received an unsatisfactory response to a Request for Reconsideration.
- New! For fastest service, submit your Claims Reconsideration or Dispute via the Provider Portal.
- Or, you can also complete and mail in the following form: Medicaid Reconsideration and Dispute Form (PDF).
Claims Trend Identification
Please use this form if you have identified a reoccurring claim trend affecting 10 or more claims with the same denial/payment codes. Instructions are on the first page.
Completed forms should be sent to your assigned Provider Engagement Administrator. Email addresses for each Representative can be found on the Regional Rep Contacts page.
Coordinated Care Payment Policies
- All Coordinated Care Payment Policies, which are used to help identify whether health care services are correctly coded for reimbursement, can be found on our Clinical & Payment Policies Page.
Claims Tools for Behavioral Health (BH) Providers
The set of claims tools below were designed specifically for Coordinated Care's Behavioral Health Providers. The BH Decision Tree guides you through some common claims and payment related issues. Take a look at Top Behavioral Denial Tip Sheet for answers to why your claim may be denying. If you are struggling with how to submit your claims, please look at our "HOW TO" document for detailed instructions on what is required on the CMS 1500 (HCFA) claim form.