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Questions?

 

How do I become part of the FamilyCare network?

If you are interested in becoming part of the FamilyCare network and you are in Multnomah, Clackamas, Washington, Morrow, Umatilla, or Clatsop counties, please fill out our Prospective Provider Survey form and fax it to (503) 734-3188.

 

How can I check the status of a claim which I have submitted?

If you are a contracted provider, you can use our Provider Portal known as the Clinical Integration Manager (CIM).  If you are a contracted provider with FamilyCare and need CIM access, please call our Provider Navigation Services at 503-222-2880 or 1800-458-9518.

My claim was rejected for No Medicaid/Medicare number, what do I need to do to get my claim processed?

Oregon Medicaid requires that all providers who provide services to Medicaid members have an active and valid Oregon Medicaid number.  If you practice within Oregon, you may contact DMAP Provider Enrollment on your own at (800) 422-5047 or provider.enrollment@state.or.us. If you are outside of Oregon or are in Oregon, but would prefer to have FamilyCare apply for an Oregon Medicaid number on your behalf, please fill out the Oregon Medicaid Application Information Form for all NPIs which need an Oregon Medicaid. The form can be faxed to Provider Services at (503) 734-3188.
Likewise, Medicare requires that all providers are enrolled in Medicare and have an active Medicare/PTAN number. If the provider in question is enrolled in Medicare, please Fax proof of Medicare enrollment to Provider Services at (503) 734-3188.

 

How do I notify FamilyCare of a change in the Medical Staff at my office?

If you have had a medical practitioner leave or join your practice, please fax written notification regarding change in office staff to Provider Services at (503) 734-3188.
Please note, if there is a new Medical Practitioner joining your clinic, they may be required to complete credentialing with FamilyCare.

 

Who needs to be credentialed and how do I start the process?

As required by state and federal regulations, all individual health care providers and/or healthcare organizations and facilities are subject to credentialing. This may include, but is not limited to: medical doctors; doctors of osteopathy; nurse practitioners; certified nurse midwives; naturopaths; podiatrists; physicians who are certified in addiction medicine; doctoral or master’s-level psychologists; master’s-level clinical social workers; master’s-level clinical nurse specialists or psychiatric nurse practitioners; other behavioral health care specialists who are licensed, certified or registered by the state to practice independently and chiropractors (Medicare only).

Health care organizations and facilities may include, but are not limited to: Durable Medical Equipment; Physical, Occupational and Speech Therapy centers; Behavioral Health Care centers; Laboratories; Free standing Radiology centers; and hospitals.

The credentialing process is initiated by providers filling out and returning the Prospective Provider Survey [link to form]and potentially the Practice/Practitioner Form to Provider Services.  The FamilyCare Credentialing department will contact providers who will need to complete the credentialing process prior to joining the FamilyCare network of providers.

 

How do I get my clinic’s demographic information updated with FamilyCare?

If you have a change in your clinic phone number, mailing address, office address or other demographic information, please Fax written notification to Provider Services at 503-734-3188.

 

How long do I have to file a claim?

For Medicare claims with dates of service on or after January 1, 2010, timely filing is one year from the date of service. For Medicare claims with dates of service before January 1, 2010, see the CMS News Release addressing timely filing.

For Medicaid claims, timely filing for non contracted providers is 120 days from the date of services.  Contracted providers, please see your contract.

 

How would I file a reconsideration/review for a claim?

You can file a reconsideration/review of a claim by choosing the appropriate link on the provider portal.  You will need to fill out the Claim Review Request form and fax it to the number listed on the form. Provide documentation to support coverage and/or explanation for reconsideration.

 

What care guidelines does FamilyCare, Inc follow?

FamilyCare follows Medicaid guidelines for FamilyCare inc. and Medicare guidelines for Family Care Premiere Care Health plans.

 

How do I submit an authorization request?

You may submit an Authorization Request through our website or print the correct form and submit via fax.

 


 

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10/03/2012
H3818_WEB_00248 CMS Approved