Providers

Claims Processing

BEGINNING DECEMBER 1, 2011

iCare claims are processed by The TriZetto Group at its Buckeystown, MD location. The TriZetto Group uses an automated claims processing system. All claims must be submitted using CMS 1500, CMS 1450/UB92/UB04 or iCare Long Term Care claim form (see below).

New Claim Mailing Addresses

  • iCare Medicare and iCare Medicaid

    •            Independent Care Health Plan
               P.O. Box 547
               Buckeystown, MD 21717

  • iCare Family Care Partnership Long Term Care Services*

    •            Independent Care Health Plan
               P.O. Box 904
               Buckeystown, MD 21717
*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 here.

Corrected Claim Mailing Addresses

Must be marked as "Corrected Claim"

  • iCare Medicare and iCare Medicaid

    •            Independent Care Health Plan
               P.O. Box 547
               Buckeystown, MD 21717
               ATTN: Operations Department

  • iCare Family Care Partnership Long Term Care Services*

    •            Independent Care Health Plan
               P.O. Box 904
               Buckeystown, MD 21717
               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 here.

2012 iCare LTC Residential Services Claim Form
2012 iCare LTC Professional Services Claim Form

Claims Filing Limits

The contracts between providers and iCare have specific claims filing limit information.

Providers are to submit all claims for services rendered where iCare Medicare is primary or iCare Medicaid is primary according to the terms of the contract. Timely filing limits apply to initial claim submissions, resubmissions and corrected claims.

Electronic Claims Submission

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

Explanation of Payment/Remittance

Providers receive an Explanation of Payment (EOP) including each claim submitted to iCare.  Effective December 5, 2011 one weekly payment for all lines of business will be sent to providers along with one EOP that identifies separate Medicare, Medicaid and Family Care Partnership payments.

Direct questions regarding the EOP to iCare Provider Services:
    Monday through Friday, 8:00-5:00
  • Local: 414-231-1029
  • Out of Area: 1-877-333-6820
  • Email: providerservices@icare-wi.org

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 for more information.

Reconsiderations

An iCare Reconsideration is a request to review a processed claim when the provider does not agree with the processing outcome. The provider has 60 days from the date of the EOP to contact iCare with an iCare Reconsideration request. The request may be made via phone, in a letter format by mail or by fax.

To make an iCare Reconsideration request, contact iCare using one of the following methods:

PHONE: call iCare Provider Services
           Monday through Friday, 8:00-5:00
           Local: 414-231-1029
           Out of Area: 1-877-333-6820

    MAIL: use the address that applies to your claim type. Mark as “RECONSIDERATION”
  • iCare Medicare and iCare Medicaid

    •            Independent Care Health Plan
               P.O. Box 547
               Buckeystown, MD 21717
               ATTN: Operations Department

  • iCare Family Care Partnership and Long Term Care Services

    •            Independent Care Health Plan
               P.O. Box 904
               Buckeystown, MD 21717
               ATTN: Operations Department

Claim Appeals

iCare encourages the provider to request an Reconsideration before going through the formal appeals process. A Provider Claim Appeal is a formal process for the provider to appeal the iCare claim decision. For more information about Provider Claims Appeals, please consult the Provider Reference Manual.

Medicaid/Family Care Partnership Appeal:
The provider should submit all provider appeals in writing by letter or form clearly marked "Appeal" and should include the provider's name, date of service, date of billing, date of rejection and reason(s) claim merits reconsideration for each appeal and submit the documentation to the following address:

Independent Care Health Plan
ATTN: OPERATIONS APPEALS
1555 N RiverCenter Drive, Suite 206
Milwaukee WI 53212-3979


If the provider is not satisfied with Independent Care Health Plan's response, the provider may request a final determination from the Department of Health Services in writing, within 60 days of Independent Care Health Plan's final decision. Appeals to the Department should be submitted to:

Provider Appeals Investigator
Division of Long-Term Care
1 West Wilson Street, Room 518
PO Box 7851
Madison, WI 53707-7851.

 

 
 
More Forms & Publications

Call 1-800-777-4376 (TTY: 1-800-947-3529), from 8:00 a.m to 8:00 p.m.,
7 days-a-week, for further information about iCare.

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