Billing & Claim Submission
This page is meant to help contracted Community Care providers seeking reimbursement for services provided to members.
Providers billing Community Care are required to use either a UB-04 claim or a standard CMS-1500 form. Community Care has provided links below to assist with submitting your billing. Please click on the link below that best describes your current billing situation or the type of services you provide.
If this is your first time billing with Community Care or to bill for general services, please click the link below:
For any questions or concerns please contact the provider hotline toll free at 1-866-937-2783 option "1" between the hours of 8 a.m. - 4:30 p.m. Monday through Friday (Central Time).
To learn more about Community Care's claim review process, please click on the link below:
Get paid faster by signing up for Electronic Funds Transfer. Use the links below:
Balance Billing of Community Care Members
Per CMS and your contract with Community Care, you can not balance-bill our members.
CMS published, as did the Social Security Act (referenced within these publications) regarding QMBs (Qualified Medicare Beneficiaries).
In Summary:
- All our dual eligible members in PACE, Partnership and Family Care are QMBs
- Federal law prohibits providers from billing QMBs for Medicare deductibles, coinsurance, or copays for any Part A or Part B service (see Sections 1902(n)(3)(B), 1902(n)(3)(C), 1905(p)(3), and 1848(g)(3)(A) of the Social Security Act [the Act])
- In states that have adopted a lessor of pay policy such as Wisconsin the state may limit their payment to the difference between the Medicaid rate and the amount Medicare has already paid which may result in no Medicaid payment if the Medicare paid amount is greater than the Medicaid allowed amount
- QMBs cannot elect to pay any Medicare deductibles, coinsurance, or copays
Billing for Medical Service Providers
For medical service providers: Community Care will only accept and process claims received electronically through a clearinghouse. In addition, we will only send you electronic remittances (ERA 835) and only issue payment via electronic funds transfer (EFT).
- Electronic billing and remittance information (PDF)
- Frequently Asked Questions on electronic billing and remittance (PDF)
- CCI Mapping to RARC (PDF)
- Skilled Nursing Facility Quick Billing Reference Manual (PDF)
Providers of Medical Services including DME, Skilled Nursing Facilities and Therapies:
Community Care accepts electronic claims through a clearinghouse. The Community Care, Inc. Payer ID is 39126. Please work with your clearing house to set up electronic billing and make sure to provide the Payer ID.
If you are not currently working with a clearinghouse, Community Care, Inc. has partnered with Office Ally, a full-service Medical Claims Clearinghouse designed to help you submit your claims electronically. Submitting your claims electronically is more efficient, results in a faster payment on claims, and may become mandatory in time. As an added bonus, providers submitting through Office Ally will not only be able to submit their claims electronically but will be auto-enrolled to receive electronic remittance advice without having to fill out an ERA enrollment form. Community Care provides all of these opportunities at no cost to you!
The contact number to enroll with Office Ally is (360) 975-7000 Option 3 and their e-mail is [email protected]
