First Health values the quality care that health care providers give to our members, and it is our goal to provide prompt reimbursement for those services.
A key factor in getting claims processed in a timely manner is correct claims submission. Submitting a claim correctly the first time increases the cash flow to your practice, prevents costly follow-up time by your office or billing staff, and reduces the uncertainty members feel with an unresolved claim.
For the First Health Network business this is especially true since First Health does not adjudicate or pay the actual claims. First Health acts as a pricer/re-pricer for their TPA/Carrier clients and, dependent on which type of relationship the TPA/Carrier client has with First Health, will determine to which electronic payer ID the initial claim should be submitted. In support of that effort, First Health has provided information below that should help clarify which payer ID applies for the patient being serviced, as well as sample ID cards, and other pertinent documentation.
Getting rejected claims?
Here are some tips:
- Submit claims per the instructions on the back of the member's ID card
- Addresses and electronic payer IDs can vary from plan to plan for submissions
- Rejected claims reports are sent weekly, with all rejections included on one report
- The report summarizes all rejections on a coversheet and includes an image of the affected claims
Coventry’s free online provider portal, directprovider.com, allows you to securely access claims and pricing sheets whenever and wherever you need to. This innovative and secure tool provides users with the ability to:
- Search for claims by Patient or Physician
- Filter claim search results
- Create customized tables to search for claims
- View and print pricing sheets
- Research and correct misdirected claims
A superior online tool, directprovider.com is designed and maintained to the highest standards, promising accurate information and faster access to the information you need, when you need it.
Register Now >> If you need help registering, please contact Net Support at 866-284-8041.
Client Reference Documents
For client specific notifications or to obtain access to the client listing, please refer to the appropriate link below. As a participating provider, it is necessary for you to have a login to access this area. In order to obtain the login, you may contact us via email and include your phone number so that our customer service representative may contact you, or you can contact the customer service department directly at 800-226-5116.