Non-Contracted Provider Resources
General Claim Requirement Information
For first time claim submission, please review the Claims & Billing webpage and the Aspirus Health Plan Medicare Advantage Provider Manual (PDF). These resources include information on billing, remittances, taxonomy, forms, links and more. Aspirus Health Plan encourages the submission of Medical Claims electronically. Guidance for electronic claims submission is provided in the Electronic Data Interchange chapter of the Aspirus Health Plan Medicare Advantage Provider Manual (PDF).
Electronic Claim Submitters – Providers must be enrolled with Aspirus Health Plan
- Complete and submit the Location Add Form as well as a completed W-9 to be enrolled in Aspirus Health Plan’s payment system.
- Within 30 business days, you will receive an email notification from us confirming you have been added to Aspirus Health Plan’s payment system.
- Submit your claim(s) electronically to Aspirus Health Plan.
A clearinghouse allows you to submit secure claims electronically. They scrub the claim for errors, then securely transmit the electronic claim to the insurance payer.
Aspirus Health Plan’s electronic claims transactions are accessible through our trading partner: Change Healthcare. Providers must contact Change Healthcare directly to enroll in available electronic transactions.
- To register, visit www.changehealthcare.com
- Aspirus Health Plan Medicare Advantage Payer ID: 36483
- Contact Information: 1-877-411-7271 or email: CHC_pcssupport@changehealthcare.com
Paper Claim Submitters
- Mail a copy of the paper claim(s), along with completed W-9 to:
Aspirus Health Plan
P.O. Box 22
Minneapolis, MN 55440-9975
Click here to download a printable W-9 (PDF).
- Guidance for paper claims submission is provided in the Claims & Payment chapter of Aspirus Health Plan’s Medicare Advantage Provider Manual (PDF).
Aspirus Health Plan requires the corresponding taxonomy to be submitted whenever a National Provider Identification (NPI) is reported on a claim submitted directly to Aspirus Health Plan or on claims that will crossover and be coordinated with Aspirus Health Plan coverage. When taxonomy is not reported on a claim that includes a NPI number(s), the claim will be rejected.
- For professional claims (submitted via 837P or CMS 1500) – billing and rendering taxonomy.
- For institutional/facility claims – billing (submitted via 837I or UB04) and attending taxonomy (submitted via 837I).
- Reference the Frequently Asked Questions: Taxonomy Code Requirements (PDF)
This process does not add your organization to Aspirus Health Plan ‘s contracted provider network. Please see the Our Network webpage if interested in becoming an Aspirus Health Plan contracted provider.
Aspirus Health Plan’s Non-Contracted Provider Payment Information
When submitting claims follow the Centers for Medicare & Medicaid Services (CMS) and standard billing guidelines. Aspirus Health Plan reimbursement will be based on CMS guidelines, Federal and State regulatory requirements.
Claim Reconsiderations (Provider Appeals)
Resources and forms for Claims Reconsideration are available on the Claims & Billing webpage under Forms & Links.
For detailed guidance see the Aspirus Health Plan Medicare Advantage Provider Manual (PDF), go to the Claims & Payment chapter and review the Non-Contracted Provider Appeal Process section.
Payment and Remittance Information
You must have access to the Aspirus Health Plan Provider Portal to request Electronic Payment and Remittance from UCare. Provider Portal access also allows you to check member eligibility and view claims, EOPs and authorizations.
If you contract with a third-party biller to call Aspirus Health Plan on your behalf, we need a signed acknowledgement form on file giving Aspirus Health Plan permission to release information. To approve a third-party biller, see the Provider Notification/Change/Update/Termination Third-Party Agreement (PDF) form.
Contact the Provider Assistance Center at 715-631-7412 or 1-855-931-4851 toll-free for guidance on prior authorization requirements, member eligibility and benefit information.
The Aspirus Health Plan Provider Portal is a secure website that allows your organization to access information needed to work with Aspirus Health Plan members. You can check member eligibility and view claims, EOPs and authorizations. You must be enrolled in the Aspirus Health Plan Claim Payment System to be granted access to the Aspirus Health Plan Provider Portal.
Ensure that Aspirus Health Plan has accurate information for your organization, location and service providers.
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