What is your electronic payer ID?
Our electronic payer ID is: 36215. However, make sure to follow claim filing directions on the back of the participant’s ID card. Many claims must be filed directly to the participant’s network in which case their electronic payer ID should be used.
What types of services require pre-certification?
All networks require pre-certification of in-patient admissions. Some networks have additional pre-certification requirements. Remember to check the participant’s ID card for requirements and follow specific network rules.
Where do I submit claims?
Claim filing instructions vary by network and type of service. Follow the instructions on the back of the participant’s ID card.
How long does it take to process a claim?
Electronic claims are usually processed within 2-3 days of being received by TeamCare and up to 30 days when further information must be reviewed such as other insurance information. Paper claims may take up to 30 days from submission.
How do I tell if a claim was received?
You can check the status of claims at Search Claims in the secure provider area of our website.
What types of services require a pre-determination of benefits?
Certain procedures require a pre-determination of benefits to be submitted directly to the member's network. For other procedures, TeamCare recommends a pre-determination of benefits be submitted into TeamCare. Please visit our Medical Pre-determination of Benefits for Providers page for more details and to access our Medical Pre-determination of Benefits Request Form.
Are there any specific plan exclusions?
TeamCare does not cover procedures that are cosmetic, experimental, or investigational in nature. A list of Plan exclusions is available in the Summary Plan Description.
How long do I have to file a claim?
Unless your network contract states otherwise, there is a 12 month filing limit on claims.
Does TeamCare provide coverage for pre-existing conditions?
Yes, TeamCare covers pre-existing conditions.
Do I contact the Network or TeamCare regarding a claim payment dispute?
If you are a Provider in one of our networks, please contact them for assistance. Otherwise Contact us.