The following billing information is designed to assist providers with specific guidelines for submitting claims to the Health Care District's District Cares program.
All claims must be submitted within one hundred and eighty (180) days from the date of service. Claims are reimbursed in accordance with contract provisions and rates. Any service not properly authorized or not considered a covered service under the benefit plan shall be denied reimbursement.
Effective for Dates of Service on or after April 1, 2019, all claims should be submitted to Community Care Plan (CCP), who is serving as the District Cares Program third-party administrator (TPA).
Community Care Plan (CCP) understands that the use of electronic healthcare transactions is of great value to the provider community. CCP and its strategic clearinghouse partner Availity are working together to promote the adoption and use of electronic health care transactions including claim transactions and electronic remittance advice, so that your organization can take better advantage of the savings available. If you are currently submitting paper claims to CCP or using a clearinghouse that is unable or unwilling to submit claims electronically to CCP’s clearinghouse, you have options available to you that will allow you to send electronic claims and start saving time and money today!
CCP and Availity partnered to offer free claim and Electronic Remittance Advice (ERA) options. We are excited to offer an enhanced free claim direct data entry option and ERA portal for your use. This option enables providers to conduct business with CCP using the following methods. These are entirely sponsored by CCP, at no cost to you:
- Enter and submit claims, receive ERA, and exchange other electronic transactions using a browser-based application over the Internet.
- Directly transmit HIPAA compliant ANSI transactions over a secure direct connection.
- If you are currently registered with Availity, access the Availity Portal to for CCP.
- If you are not currently registered with Availity, you can register at availity.com to use the Availity Portal for CCP.
- For assistance with registration to the Availity portal, please access an on-demand training video.
- To learn more about these options, visit www.availity.com or contact Availity at 1-800-282-4548. We know you will enjoy industry leading products and services that will bring value to your organization!
- Clearinghouse: Availity
- Payer Name: Community Care Plan (Palm Beach Health District)
- Payer ID: PBHD1
To obtain online claim status please utilize the Provider Portal at http://planlink.ccpcares.org
Paper claims that require attachments or claims appeals should be mailed to:
CCP/HCDPBC Claims Department
P.O. Box 841109
Pembroke Pines, FL 33084
Appeals must be submitted using the CCP Request for Reconsideration Form available at www.ccpcares.org
For Dates of Service prior to April 1, 2019, claims should be submitted to the Health Care District.
Claims shall be submitted for payment on standard claim forms. The CMS-1500 form shall be utilized for all non-institutional services and the UB-04 for institutional services. You may also submit professional claims on a Health Insurance Portability Accountability Act (HIPAA) compliant X12 electronic file upon completion of Electronic Data Interchange (EDI) testing with the Plan. If applicable, a copy of the referral form and/or authorization reference number should be attached to the claim.
Mail all District Cares paper claims to the following address:
Health Care District of PBC
1515 N. Flagler Dr., Suite 101
West Palm Beach, FL 33401-3429
Payments made for District Cares are considered paid in full for services rendered. Providers may not balance bill any members of the District Cares program for any covered service. This is outlined in the provider agreement under Compensation.
Member Financial Responsibility
Members will bear full financial responsibility for payment of all charges for services for the following:
- Non Covered services
- Covered services provided by a non-participating provider or facility
- Services provided beyond the member’s benefit maximum
Billing for Non-Covered Services
Provider shall not, either directly or indirectly, bill, charge, or seek compensation from Members for Covered Services rendered; provided, however, that nothing herein shall be construed to prohibit Provider from collecting or pursuing collection of Program authorized Copayments or charges for non-Covered Services or seeking payment from other Payors. Prior to providing non-Covered Services to a Member, Provider shall:
- Inform the Member that the services to be provided are not Covered Services;
- Inform the member that Program will not pay or be liable for such services;
- Inform the Member in writing that if Provider is seeking compensation for such services, the Member shall be financially liable for such services;