Claims

Preferred Option: Submit Claims Online

Providers have the option to submit claims through our secure Provider Portal. You can submit claims and any necessary attachments, track claim payments, and more. CSMV offers this service at no cost.

We encourage you to submit claims online to take advantage of the following benefits:

• Faster claim processing
• Reduced administrative costs
• Reduced probability of errors or missing information
• Faster feedback on claim status
• Minimal staff training or cost

What Types of Claims Can Be Submitted?

• Professional medical office claims (CMS 1500 and 837P)
• Institutional claims for Inpatient and Outpatient Services (UB-04 and 837I)

Note: For more information on the TRICARE Dental Program, please refer to www.tricare.mil/CoveredServices/Dental.

Atypical Providers

When an atypical provider submits claims, TRICARE Prime Demo requires a National Provider Identifier (NPI) from providers. If a provider submitting a claim does not have an NPI, then they should submit the NPI of the billing and supervising provider.

Billing Provider *Required Data / In the Rendering Provider field will be the Supervising Provider’s information: *Required Data – NPI – TAX ID

Get Paid Electronically

We partner with ECHO Health, Inc. to deliver provider payments. ECHO offers three payment options:

1. 1
   Electronic fund transfer (EFT)Preferred
2. 2
   Virtual Card Payment (QuicRemit)Standard bank and card issuer fees apply*
3. 3
   Paper Checks

*Payment processing fees are what you pay your bank and credit card processor for use of payment via credit card.

Enrollment Instructions

Enroll with ECHO for payment and choose EFT as your payment preference for CareSource.

Electronic Claim Submission

Electronic Data Interchange (EDI) is the computer-to-computer exchange of business data in ANSI ASC X12 standard formats. EDI transmissions must follow the transaction and code set format specifications required by the Health Insurance Portability and Accountability Act (HIPAA). CSMV has invested in an EDI system to enhance our service to network providers. Our EDI system complies with HIPAA standards for electronic claims submission.

Clearinghouse

CSMV prefers electronic claim submission. To submit claims electronically, providers must work with an electronic claims clearinghouse. We currently accept electronic claims from providers through the clearinghouse listed below. Contact the clearinghouse to begin electronic claims submission.

Alternative Option: Paper Claims

Paper claim forms are encouraged only for services that require clinical documentation or other forms to process. Refer to the Provider Manual for instructions to submit paper claims.

Providers can upload paper claims via the Provider Portal. You can also mail or fax paper claims to the following address:

Non-Participating Providers

Non-participating providers may submit claims to CSMV using the Non-Participating Provider Profile Form. We are unable to process claims without this information. Please be sure to attach your W-9 form when you submit this online form.