PsycHealth, Ltd. processes claims in accordance with the guidelines of the state Prompt Pay Laws.
Clean claims will be processed within 30 days of the date received. All claims for services rendered must be submitted on a completed CMS1500 Form or UB92 Form or equivalent.
PsycHealth accepts claims electronically through the Provider Portal and in paper format. To submit your printed claims please submit them to the address below:
Claims Processing Department
P.O. Box 5312
Evanston, IL 60201
The Provider Portal, also known as QC Portal, is a comprehensive managed care software that is highly flexible, easy to use and powerful. The software allows PsycHealth providers to verify eligibility, enter referral and authorization requests, submit claims and view the status of all data in real-time from any internet web browser. If you need access to the portal and you are eligible, contact us to schedule a training.
CPT-4 Coding must be utilized on all submitted claims.
ICD-9 Coding for services prior to 10/1/2015 and ICD-10 Coding for services on 10/1/2015 and after are required. If you are having trouble converting ICD-9 codes please visit the Center for Medicare and Medicaid Services for additional help.
Member co-payments are to be collected by the provider at the time of services rendered. PsycHealth, Ltd. will deduct co-payments from the rate of reimbursement when processing claims. Under no circumstances is a member responsible for any payment beyond the specified plan co-payment.
Claims status inquiries can be obtained during normal business hours by calling:
A Clean Claim is defined as:
A claim that has no defect, impropriety, lack of any required substantiating documentation, or particular circumstances requiring special treatment that prevents timely payment.
A Clean Claim must include the following information at a minimum:
- Member Name
- Member Identification Number
- Date of Birth
- Insurance Carrier
- Group, Site and COC Numbers
- Provider Name and Title
- Federal Tax Identification Number
- Location at which the services were provided
- Date(s) of Service
- Place of Service Code
- DSM-IV Diagnosis
- Revenue Code
- Authorization number