Care N’ Care Insurance Company of North Carolina, Inc. program is changing its provider services for EFT processing to RedCard Systems in Quarter 4 of 2019.
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.
Beginning early December, current EFT enrollees will receive unique letters (dependent on current RedCard enrollment) with special invitation codes to establish access (see samples below). 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 RedCard 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?
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
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.