Provider Claims Tools
The Coordinated Care Claims and Payment Decision Tree can help guide you through some common claims and payment-related issues. Within this document, you’ll find the steps you’ll need to take if:
- Your claim was denied
- You are awaiting payment for a submitted claim
- You have a question about how your claim processed
- You’ve noticed a concerning trend in your claim denials/payments
- You want a progress update on an existing claim issue
Download a copy of the Claims and Payment Decision Tree (PDF)
Take a look at our Claims and Payment FAQ document for answers to over 30 of the most commonly asked claims-related questions.
A Request for Reconsideration (Level I) is a communication from a provider about a disagreement with the manner in which a claim was processed. A Reconsideration can be submitted to Coordinated Care via the Provider Portal, or by mailing a completed Reconsideration and Dispute form to the address listed on the form. A Claim Dispute (Level II) should be used only when a provider has received an unsatisfactory response to a Request for Reconsideration.
Have you noticed an underlying or ongoing issue that is impacting 10+ of your practice’s Coordinated Care claims? Instead of digging through your records to identify all potentially impacted claims, you can alert Coordinated Care to the issue my providing one example claim and a brief description of the trend you are seeing.
If you do identify a claims trend issue, please fill out the Claim Trend Identification PDF below, and then return it to CoordinatedCareProvi@Centene.com.
- All Coordinated Care Payment Policies, which are used to help identify whether health care services are correctly coded for reimbursement, can be found on our Clinical & Payment Policies Page.
The set of claims tools below were designed specifically for Coordinated Care's Behavioral Health Providers. The BH Decision Tree guides you through some common claims and payment related issues. Take a look at Top Behavioral Denial Tip Sheet for answers to why your claim may be denying. If you are struggling with how to submit your claims, please look at our "HOW TO" document for detailed instructions on what is required on the CMS 1500 (HCFA) claim form.