Provider Quick Reference - INTotal Health

Important Phone Numbers Precertification/Notification Requirements Revenue CodesProvider Quick Important Contact Information Our Service Partners Claims ServicesTimely filing is within 180 calendar days from the date of the clearinghouse with any accept claims through four clearinghouses: Emdeon (payer 10262) Gateway (payer IHP01) Capario (payer IHP01) Availity (payer IHP001 - professional claims only) Availity (payer IHP002 - institutional claims only)Paper ClaimsSubmit claims on original claim forms (CMS 1500 or CMS 1450) printed with dropout red ink or typed (not handwritten) in large, dark font. AMA- and CMS-approved modifiers must be used appropriately based on the type of service and procedure code. Mail to:Claims INTotal Health Box 5446 Richmond, VA 23220-0446 Payment DisputesClaims payment disputes must be filed within 90 days of the adjudication date on your explanations of payment. Forms for Provider appeals are available on our website. Mail to: Payment Dispute Unit INTotal Health 2600 Park Tower Drive, Suite 600 Vienna, VA 22180 Medical AppealsMedical appeals, or medical administrative reviews, can be initiat-ed by members or providers on behalf of members and must be submitted within 30 calendar days from the dates of the notices of proposed actions.

Plastic/Cosmetic/Reconstructive Surgery (Including Oral Maxillofacial Services) No precertification is required for coverage of E&M codes.

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