HCP manages care for Anthem Medicare Advantage patients and is responsible for claims payment to providers who are directly contracted with HCP (HCP DIRECT providers).
How do I determine if an Anthem Medicare Advantage member is managed by HCP?
There are two areas of the member’s ID card that will verify if a member is managed by HCP
- Front of the ID card: “HealthCare Partners, IPA” is listed below the PCP’s name in the middle-right of the front of the member’s ID card.
- Back of ID card: The HCP Provider Services telephone number for Authorizations, (844) 638-0404, is listed on the right of the back of the ID card.
Providers who are contracted directly with HCP (HCP DIRECT providers) should submit claims to HCP.
Electronic (EDI) Claims
HCP’s preferred method of claims submission is electronic through Availity. This process streamlines your claims, improves response time, and enhances correction capabilities. In addition, it provides you with a record of your claim upload.
Create an Account with Availity
In order to submit claims via EDI through Availity to HCP, you must first Log In or Register as necessary with the Availity Essentials Portal at www.availity.com. For assistance, contact Availity at (800) 282-4548
To Submit HCP Direct Claims:
HCP’s Payer ID number with Availity is 11328.
Helpful Tips for Successful EDI Transmission
- Submit EDI claims with the Provider’s full and proper name and National Provider Identifier (NPI) number.
- Verify that the Member’s first and last names, health plan ID, and date of birth match eligibility records. Mismatched patient information may result in the rejection of your claim.
- Retain copies of your EDI transmission acceptance reports as evidence of transmission.
Paper Claims
All paper claims must be submitted on a properly completed CMS 1500 or UB04 claim form and faxed to (516) 515-8870.
Helpful Tips for Successful Paper Claim Submission
- Be sure to properly complete your claim form. Any missing or omitted information may lead to a delay in processing or rejection of your claim.
- Always include your Tax ID Number and NPI (National Provider Identification) number.
- The Centers for Medicare and Medicaid Services (CMS) requires that ICD-10 codes be submitted at the highest level of specificity. Failure to submit the most specific ICD-10 code(s) may result in rejection of your claim.
- Do not use colored highlighters on your claim forms. All paper documents are scanned using light-sensitive equipment. Highlighted areas can become fully obscured during the scanning process.
Providers who do not hold a HCP direct contract (are not HCP DIRECT providers) should submit claims for HCP members to Anthem by following instructions from Anthem.
Timely Filing
The timely filing for Medicaid, Medicare, and Commercial claims is: within 120 days of the date of service. Where HCP is the secondary payor under Coordination of Benefits, the time period shall commence once the primary payor has paid or denied the claim.
Check Claim Status with EZ-Net
Use EZ-Net, HCPs secure web-based data exchange application, to view the status of an existing claim previously submitted to HCP.
Login credentials for EZ-Net are required. Learn more about EZ-Net.
Claim Reconsideration
As a participating HCP provider, you may request a Claim Reconsideration for any claim submission to HCP that you feel was not properly processed. Please download the Claims Reconsideration Request Form and follow the instructions.
Completed forms can be faxed to (516) 394-5693.
Out-of-Network Providers Submitting Medicare Advantage Claims
For claims denials that resulted in partial or zero payment: You are only permitted to file a standard appeal for a denied Medicare Advantage claim if you complete a Waiver of Liability, which states that you will not bill the member regardless of the outcome of the appeal.
You must file the appeal within 60 calendar days from the date of this explanation of payment.
