HealthTeam Advantage changed its provider services for EFT processing to Zelis (formerly RedCard Systems) in January 2020.
It is important to note that in order to continue receiving EFT payments from Care N’ Care Insurance Company of North Carolina, Inc., it is required that you enroll with RedCard. Failure to enroll will mean future payments will be issued by paper check.
It’s important to note that in order to continue receiving EFT payments from Care N’ Care Insurance Company of North Carolina, Inc., it is required that you enroll with Zelis. Failure to enroll will mean payments will be issued by paper check. You may still register without the letter, by enrolling here *.
*All new enrollments require account confirmation to finalize enrollment. A test deposit will be sent to your account on file. Once the test deposit is received, be sure to login to Zelis to record and verify this test deposit amount.*
In-network providers are able to request access to the Acuity Connect Portal. Unfortunately, we are unable to accept out-of-network provider requests for portal access at this time.
Follow the instructions below to register for access:
Step 1: Complete the below form.
Step 2: Once the form is submitted, it is reviewed by provider concierge. If you are an in network provider, you will be sent a link to a training module.
Step 3: Complete the training module and required credentials. Once completed, you will receive an email invitation within 2-5 business days.
Step 4: You will receive an email invitation to the THN-UM Acuity Connect Portal. Once you complete the new login process, you will have access to the portal.
2019 Prior Authorization List:
HealthTeam Advantage recognizes the hard work done by physicians and their staff in obtaining authorizations for our Medicare Advantage patients. We are working to further simplify the process, while ensuring patients receive the right care, at the right time, in the right setting. HTA has greatly reduced the number of procedures that require prior authorization. Over 2,000 codes have been removed. Important information is included in the letter found on this link.
The list below outlines services and medications for which prior authorization in 2020 is required for HealthTeam Advantage members. Please review the key information at the top of the list for important information before submitting a prior authorization request.
If you do not have access to the portal, please print and complete the applicable prior authorization form found below. Important reminder: the form must be complete and include clinicals to support medical necessity. If you have any questions or to verify if a procedure requires prior authorization, please contact our intake team at: 844-873-2905 8 AM to 5 PM M-F and 336-604-1589 after 5 PM.
Please allow eight to ten (8-10) days turn-around time for processing. Note, per CMS the standard turn-around time is fourteen (14) days.
The Member ID card has a separate phone number for Dental, Vision, and Hearing. Is that the number I call for those benefits?
The phone number on the ID card is for members who have the supplemental combination rider, which is for dental, vision, and hearing OR for members who have the supplemental dental rider only. If they did not enroll for either supplemental rider, call the benefits and eligibility line, 844-806-8217 (Option 1).
Who do I contact if I have questions about my contract or need a copy of my contract?
Why is BetterDoctor asking me to update my information in the provider directory?
Triad HealthCare Networks (THN’s) Provider Data Management team started using BetterDoctor, the nation’s most accurate provider data management platform, to validate HealthTeam Advantage’s (HTA’s) provider directory. The Centers for Medicare & Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA) require health plans to engage providers in reviewing and maintaining provider directory information. Read more here.
What is the HealthTeam Advantage Diabetes & Heart Care HMO CSNP?
The HealthTeam Advantage Diabetes & Heart Care HMO CSNP is a Health Maintenance Organization (HMO) Chronic Special Needs Plan (CSNP) available to Medicare beneficiaries who reside in Guilford county. The beneficiaries must have diabetes and/or congestive heart failure (CHF) that is verified by an HTA network provider to enroll in the plan. To complete the enrollment in the CSNP, your patients must confirm they have a qualifying condition of diabetes or congestive heart failure by having YOU complete this verification form. HealthTeam Advantage will need to obtain the attestation verbally or written within the enrollee’s first 30 days of coverage to remain enrolled in the Chronic Special Needs Plan. To assist your patients in completing the enrollment process, HealthTeam Advantage will be calling to verify the chronic disease or faxing an attestation form to your office to complete and return to HealthTeam Advantage. If we are unable to obtain the attestation verbally or written within 30 days of the effective date of coverage, a dis-enrollment from the plan will occur.
When your office receives attestation forms, act immediately to keep your patients enrolled in the HTA Diabetes & Heart Care HMO CSNP.
For 2020, DRG Claims Management (a HealthTeam Advantage business associate [BA]) will conduct pre- and post-payment reviews of selected acute inpatient claims reimbursed with diagnosis related group (DRG) payment methodology. The purpose of the reviews is to verify the submitted diagnosis and procedure codes and the discharge disposition submitted on the UB-04 claim form are supported by the medical record documentation and in accordance with The Official Guidelines for Coding & Reporting for ICD-10 CM and PCS and other officially approved resources. We want to ensure accurate payments were made by the HealthTeam Advantage in accordance with Medicare Revenue Integrity Program standards.
To perform the reviews, DRG Claims Management is authorized (as a BA) to request and receive supporting clinical information in the medical records and/or billing documentation. Please be assured that only a select sample of previously paid claims will be audited, and every effort will be made to limit the number of records requested at any one time. Once you receive the request, kindly mail or transmit the medical records to the location indicated on the request form.
In the event coding changes are recommended, HealthTeam Advantage or DRG Claims Management will provide a “Coding Inquiry” (a detailed explanation including supporting coding references). We will provide a Provider Confirmation form to sign and indicate either your agreement or disagreement to coding change recommendations. We will contact the appropriate department to obtain contact information for medical record requests and coding inquiries. We value our relationship with you and thank you in advance for your assistance.
DRG Claims Management is a BA of HealthTeam Advantage, as defined in 45 CFR 160.103, and its uses and disclosures of protected health information and other actions are consistent with HealthTeam Advantage’s privacy policies, as stated in our privacy practice notice. In accordance with these references, any information provided to our business associate will not be disclosed to any third party except as permitted.
Dispute: A dispute occurs when a contract provider disagrees with payment from the plan. It involves issues that have occurred after services have been rendered. This can include a review of the claim allowed amounts, the amount paid, denials, etc. The dispute is the only option available to contracted providers.
Appeal: An appeal is a formal request from a non- contracted provider requesting a review of a previous claim decision resulting in a denial by the plan that results in zero payment made to the non-contracted provider. The denial can happen on the entire claim, or on a line item. Appeal rights are only available to non-contracted providers. For more information on this process, click here.
Who Can Submit a Dispute?
A contracted provider with HealthTeam Advantage/Teal Premier has the right to dispute claims processing and payments
All disputes must be filed with 120 days from the claims adjudication date on the Explanation of Payment (EOP) to submit a dispute
When Should You Submit a Dispute?
You should submit a dispute when you believe a claim was paid incorrectly. The situation for reprocessing includes, but is not limited to:
Amount paid is different than what the provider expected
The claim was filed in a timely manner and the provider has proof
The claim was denied for no authorization when the provider has an authorization number
All supporting documentation such as medical records and provider statement support claims payment
How to Submit a Dispute
Send a dispute letter that includes the following:
Provider Tax ID
Date of Service
A detailed explanation of the dispute and supporting documentation
Introducing the Optum In-Office Assessment Program
Beginning August 10, 2020, we have partnered with Optum in their in-office assessment (IOA) program.
What is the Optum in-office assessment program?
The Optum® in-office assessment program promotes early detection and ongoing assessment of chronic conditions for our health plans’ Medicare Advantage members. The assessment should be used prospectively at the point of care. The goal of the in-office assessment program is to help ensure that these patients receive a comprehensive annual exam and to support a variety of quality programs, including The Healthcare Effectiveness Data and Information Set (HEDIS®) and the Five-Star Quality Rating System.
The in-office assessment program provides historical information about patients to the provider. This health information may include:
PCP, specialists, and hospitalization history
Information on previously diagnosed conditions
Potential gaps in preventive screenings or recommended chronic illness treatment
The in-office assessment program allows for identification and accurate reporting of chronic conditions. Optum will work with you to determine which delivery method is most suitable for your practice.
Why is the in-office assessment program important to providers?
Routine exams and screenings can help identify and detect chronic conditions, often before your high-risk patients have any symptoms. These annual exams are an important part of maintaining the quality of care and quality of life of your patients.
The in-office assessment and reimbursement
When you accurately complete and submit your provider assessment form (PAF) and supporting medical record documentation, you may be eligible for reimbursement.
The “Pay to” TIN on the Account Setup Form must match the TIN on your W-9.
Your completed Account Setup Form and your W-9 must be submitted prior to submission of a completed assessment to ensure that your reimbursement account setup has been completed by Optum.
Account Setup Forms (ASFs) and W-9s are required to qualify for any eligible assessment reimbursements. Reimbursements for eligible assessments will be paid monthly for all assessments made the PRIOR Failure to timely submit your ASF and W-9 acts as a waiver of any and all claims for the program year reimbursement.
HealthTeam Advantage works diligently to process and make payments correctly to your claims the first time. Unfortunately, a processing error can happen, and an overpayment occurs. When we identify an overpayment, the refund request process begins. We are unable to process “recoupments” or “take-backs” at this time but are working to add this option soon.
The refund process is as follows:
A letter is mailed to the provider requesting a refund.
The letter will contain information regarding the claim that has an overpayment and what the reason is for the overpayment.
We will provide you with the member ID, name, and date of services.
If there are multiple refund requests for the same reason, we will provide a spreadsheet with each member’s information, dates of services, and overpayment amount.
If the refund is not received within 30 days, we will send you another letter. Three letters will be sent over 90 days to collect. Failure to submit the requested monies could result in collection action.
All refunds are to be mailed directly to the Plan:
7800 McCloud Road, Suite 100
Greensboro, NC 27409
Should you have any questions regarding a refund request letters you received, please call your provider concierge for HealthTeam Advantage at 844-806-8217 (option 2).
HealthTeam Advantage, a product of Care N’ Care Insurance Company of North Carolina, Inc., is a Medicare Advantage plan with a Medicare contract. Enrollment in HealthTeam Advantage depends on contract renewal. This information is not a complete description of benefits. Call for more information: prospective members call 877-905-9216 , HTA PPO members call 888-965-1965, and HTA CSNP members call 833-324-3242 (TTY:711) from October 1–March 31, 8 a.m. to 8 p.m. ET, seven days a week, or April 1–September 30, 8 a.m. to 8 p.m. ET, Monday through Friday. Medicare beneficiaries may also enroll in HealthTeam Advantage through the CMS Medicare Online Enrollment Center located at http://medicare.gov. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
Every year, Medicare evaluates plans based on a 5-star rating system.