Fee Participating Claims Claims Inquiry Authorization ...

Plan Name Type of Plan Fee Participating Claims Claim
Schedule Providers Address Ph
ADVANTAGE 360 ( Self-funded)
Optional Advantage 360 CHI Employed . Non see member ID see mem
Fee Schedule Employed can accept or card card
reject.

ADVANTAGE Health Solutions HMO Prime ProHealth Risk ProHealth Prime PCP's, ProHealth ProHea
Fee Schedule
Prime OB GYN's & Prime Claims Custom
Medicare Fee
Schedule SCP's Processing (317) 6

P.O. Box 50407 (800) 3

Indianapolis, IN

Aetna Medicare Advantage PPO Medicare CHI Employed & LLC see member ID see mem

providers only card card

Aetna US Healthcare / PPO / POS / EPO Community Aetna Fee CHI Employed & LLC see member ID see mem
Hospital Schedule providers only card card

Employed & LLC

Anthem Healthy Indiana Plan (HIP) Community Medicaid CHI/CHA Employed see member ID see mem
Ages 19-64 Hospital providers only card card
Employed

Anthem Blue Cross Blue Shield HMO / Community Anthem Fee CHI/CHA Employed see member ID see mem
Schedule providers only card card
PCI / PPN Traditional / Blue Hospital

Employed & LLC

Anthem Medicaid Community Medicaid Fee CHI/CHA Employed see member ID see mem
Ages 0-18 Hospital Schedule providers only card card
Employed

ms Inquiry Authorization In-Network Facilities Billing Hints / Notes
hone # Process Fee Schedule

mber ID see member ID card Community Hospitals Indy & WEBSITE: (www.advantageplan.com)
Anderson, Howard, Westview
(call # on ID card for add'l WEBSITE: (www.advantageplan.com)
facilities)
WEBSITE: (www.aetna.com)
alth Refer to Provider Community Hospitals Indy &
mer Service Directory for list for Anderson, Howard, Westview WEBSITE: (www.aetna.com)
621-7565 or provider referrals; (call # on ID card for add'l
344-8672 otherwise, call Med facilities) Excludes pediatrics
Mgmt for
mber ID Community Hospitals Indy & WEBSITE: (www.anthem.com)
see member ID card Anderson, Howard, Westview 1)Anthem assigns their own effective date
(call # on ID card for add'l which takes up to 120 days.
facilities)

mber ID see website Community Hospitals Indy & 120 day billing
Anderson, Howard, Westview deadline
(call # on ID card for add'l
facilities)

mber ID see member ID card Community Hospitals Indy &
Anderson, Howard, Westview
(call # on ID card for add'l
facilities)

mber ID see member ID card Community Hospitals Indy & 90 day billing
Anderson, Howard, Westview deadline
(call # on ID card for add'l
facilities)

mber ID see member ID card Community Hospitals Indy &
Anderson, Howard, Westview
(call # on ID card for add'l
facilities)

Plan Name Type of Plan Fee Participating Claims Claim
Schedule Providers Address Ph

Anthem Preferred Medicare PPO/HMO Community Medicare Fee CHI/CHA Employed see member ID see mem
Hospital Schedule providers only card card

Employed & LLC

Anthem Medicare HMO Community Medicare Fee CHI/CHA Employed see member ID see mem
Beech Street Hospital Schedule providers only card card

Employed & LLC

Basic ProHealth PPO All ProHealth providers see member ID see mem
card card
Fee Schedule

Caresource Medicare Community Medicare Fee CHI/CHA Employed see member ID see mem
Central IN Health Partners Hospital Schedule providers only card card

Employed & LLC

Basic ProHealth Risk All ProHealth Providers see member ID see mem
card card
Fee Schedule

CIGNA HMO/PPO/POS- No Mid Levels Community CIGNA Fee CHI/CHA Employed & see member ID see mem
Schedule LLC card card
(No Behavioral Care Providers) Hospital providers

Employed & LLC

Cofinity (formerly PPOM) Optional Cofinity Fee CHI Employed. Non see member ID see mem
Schedule Employed can accept or card card
reject.

Community Health Alliance Community Community CHI/CHA Employed & see member ID see mem
LLC card card
Hospital Health providers

Employed & LLC Alliance Fee

Schedules

ms Inquiry Authorization In-Network Facilities Billing Hints / Notes
hone # Process Fee Schedule

mber ID see member ID card Community Hospitals Indy & Follows Medicare WEBSITE: (www.anthem.com)
Anderson, Howard, Westview guidelines. 1) Anthem assigns their own effective date.
(call # on ID card for add'l 2) Plan is not currently active in the
facilities) Anderson area.
3) Plan utilizes Medicare fee schedule (See
attachment for fee inquires)

mber ID see member ID card Community Hospitals Indy & WEBSITE: (www.anthem.com)
mber ID see member ID card Anderson, Howard, Westview 1)Anthem assigns their own effective date
mber ID (call # on ID card for add'l which takes up to 120 days.
mber ID facilities)
mber ID WEBSITE: (www.beechstreet.com)
mber ID Community Hospitals Indy & 1) Plan utilizes ProHealth PPO fee schedule
mber ID Anderson, Howard, Westview (See attachment for fee inquires)
(call # on ID card for add'l
facilities)

see member ID card Community Hospitals Indy &
Anderson, Howard, Westview
(call # on ID card for add'l
facilities)

see member ID card Community Hospitals Indy &
Anderson, Howard, Westview
(call # on ID card for add'l
facilities)

see member ID card Community Hospitals Indy & 180 day claims filing WEBSITE: (www.cigna.com)

Anderson, Howard, Westview limit. No Mid-Levels

(call # on ID card for add'l

facilities)

see member ID card Community Hospitals Indy & WEBSITE: www.confinity.net
Anderson, Howard, Westview 1) Plan falls under Aetna.
(call # on ID card for add'l
facilities)

see member ID card Community Hospitals Indy &
Anderson, Howard, Westview
(call # on ID card for add'l
facilities)

Plan Name Type of Plan Fee Participating Claims Claim
Schedule Providers Address Ph

CorVel Workers Compensation Network Workers Comp. ProHealth Optional for ALL see member ID see mem
Workers
Comp. Fee providers. One agreement card card
Schedule
for all 4 plans.

Coventry National / First Health Basic ProHealth PPO All ProHealth providers see member ID see mem
Network
Fee Schedule card card

encircle EPO Optional Encircle EPO CHI Employed . Non see member ID see mem
Fee Schedule Employed can accept or card card

reject.

Encore PPO Optional Encore PPO CHI Employed . Non see member ID see mem
Fee Schedule Employed can accept or card card

reject.

Encore Work Comp Plan Workers Comp. ProHealth Optional for ALL see member ID see mem

Workers Comp providers. One agreement card card

Fee Schedule for all 4 plans.

First Health / FOCUS Worker's Comp Workers Comp. ProHealth Optional for ALL see member ID see mem
Workers
Comp. Fee providers. One agreement card card
Schedule
for all 4 plans.

Fortified Provider Network Optional Fortified CHI Employed . Non see member ID see mem
Galaxy Health Network Optional card card
Provider Employed can accept or
see member ID see mem
Network Fee reject. card card

Schedule (Pays

90% of billed

charges)

Galaxy Health CHI Employed . Non

Network Fee Employed can accept or

Schedule (Pays reject.

85% of billed

charges)

ms Inquiry Authorization In-Network Facilities Billing Hints / Notes
hone # Process Fee Schedule

mber ID see member ID card Community Hospitals Indy & WEBSITE: (www.corvel.com)
mber ID Anderson, Howard, Westview Agreement includes Corvel, First
mber ID (call # on ID card for add'l Health,USA/MCO and Encore Work Comp
mber ID facilities) Plans.
mber ID
mber ID see member ID card Community Hospitals Indy & WEBSITE: (www.coventrynational.com)
mber ID Anderson, Howard, Westview Acquired by Aetna.
(call # on ID card for add'l
facilities) WEBSITE:
(www.encorehealthnetwork.com)
see member ID card Community Hospitals Indy & Encore and Encircle effective date will be
Anderson, Howard, Westview one month following the ProHealth
(call # on ID card for add'l Effective date.
facilities) WEBSITE:
(www.encorehealthnetwork.com)
see member ID card Community Hospitals Indy & Encore and Encircle effective date will be
Anderson, Howard, Westview one month following the ProHealth
(call # on ID card for add'l Effective date.
facilities) WEBSITE:
(www.encorehealthnetwork.com)Agreemen
see member ID card Community Hospitals Indy & t includes Corvel, First Health,USA/MCO
Anderson, Howard, Westview and Encore Work Comp Plans.
(call # on ID card for add'l
facilities) WEBSITE:
(www.encorehealthnetwork.com)Agreemen
see member ID card Community Hospitals Indy & t includes Corvel, First Health,USA/MCO
Anderson, Howard, Westview and Encore Work Comp Plans.
(call # on ID card for add'l
facilities) WEBSITE: (www.fortifiedprovider.com)

see member ID card Community Hospitals Indy &
Anderson, Howard, Westview
(call # on ID card for add'l
facilities)

mber ID see member ID card Community Hospitals Indy & 120 day claims filing WEBSITE: (www.ghn-mci.com)

Anderson, Howard, Westview limit for 1) Galaxy fee schedule is 90% billed

(call # on ID card for add'l most GHN payers charges

facilities)

Plan Name Type of Plan Fee Participating Claims Claim
Schedule Providers Address Ph
Gold Plan
Prime PH Risk Fee ProHealth Prime PCP's, see member ID see mem
Schedule
Prime OB GYN's & Prime card card

SCP's

HealthNet Tricare (Military) Community Champus Fee CHI/CHA Employed & see member ID see mem
card card
Hospital Schedule LLC

Employed & LLC providers

Humana ChoiceCare Medicare Community Medicare Fee CHI Employed Only. see member ID see mem
Advantage card card
PPO / Gold Choice PFFS Hospital Schedule

Employed & LLC

Humana Gold Plus HMO- Medicare Community Medicare Fee CHI Employed Only. see member ID see mem
Advantage card card
Hospital Schedule

Employed & LLC

IHN Community IHN Fee CHI/CHA Employed & see member ID see mem

Hospital Schedule LLC card card

Employed & LLC providers

IU Medicare Plan Community Medicare Fee CHI Employed Only. see member ID see mem
card card
Hospital Schedule

Employed & LLC

Lutheran Preferred Prime ProHealth PPO ProHealth Prime PCP's, see member ID see mem

Fee Schedule Prime OB GYN's & Prime card card

SCP's

MHS (Managed Health Services- Medicaid Medicaid Fee CHA employed PCP's and
Medicaid)
HIP and Medicaid Schedule CHI/CHA/Howard/Westvi

ew SCP's

ms Inquiry Authorization In-Network Facilities Billing Hints / Notes
hone # Process Fee Schedule

mber ID see member ID card Community Hospitals Indy & Community Health Network Employee
mber ID Anderson, Howard, Westview Benefit Plan
mber ID (call # on ID card for add'l
mber ID facilities)
mber ID
mber ID see member ID card Community Hospitals Indy & Access website for WEBSITE: (www.hnfs.net),
mber ID Anderson, Howard, Westview specific info. (www.mytricare.com) &
(call # on ID card for add'l (www.healthnetfederalservices.com)
facilities) 1) HealthNet assigns their own effective
date.
see member ID card Community Hospitals Indy & Follows Medicare
Anderson, Howard, Westview guidelines. WEBSITE: (www.humana.com)
(call # on ID card for add'l 1) Plan is not currently active in Anderson
facilities) area.
2) Plan utilizes Medicare fee schedule
see member ID card Community Hospitals Indy & Follows Medicare (See attachment for fee inquires)
Anderson, Howard, Westview guidelines.
(call # on ID card for add'l WEBSITE: (www.humana.com)
facilities) 1) Plan utilizes Medicare fee schedule
(See attachment for fee inquires)

see member ID card Community Hospitals Indy & WEBSITE: (www.ihnppo.com)
Anderson, Howard, Westview Now owned by CIGNA
(call # on ID card for add'l
facilities)

see member ID card Community Hospitals Indy & Follows Medicare
Anderson, Howard, Westview guidelines.
(call # on ID card for add'l
facilities)

see member ID card Community Hospitals Indy & WEBSITE: (www.luthernpreferred.com)
Anderson, Howard, Westview
(call # on ID card for add'l
facilities)

Community Hospitals Indy & INCLUDES All specialists plus:OB/GYN ,
Anderson, Howard, Westview NP's , Symptom Management Group,
(call # on ID card for add'l Comm Group Clinicians, but EXCLUDES:
facilities) Behavioral health, PA's, and PCP's

Plan Name Type of Plan Fee Participating Claims Claim
Schedule Providers Address Ph

MDwise ProHealth, Hoosier Care Medicaid Medicaid Fee CHI Employed SCP's & ProHealth ProHea
Connect, Behaioral Health, HIP and
Medicaid Schedule Howard all PCP's and MDwise Claims Custom

SCP's Processing P.O. (317) 6

Box 50407 (800) 3

Indianapolis, IN

Multiplan Basic ProHealth PPO All ProHealth Providers see member ID see mem
Fee Schedule
card card

Private Healthcare Systems (PHCS) Basic ProHealth PPO All ProHealth providers see member ID see mem

Feel Schedule card card

Sagamore Plus PPO/Ambassadore POS Optional Sagamore PPO All ProHealth Prime see member ID see mem
card card
& POS Fee providers may opt to

Schedule participate

Secure Horizons / Evercare United Community Medicare Fee CHI/CHA Employed & see member ID see mem
Healthcare card card
Hospital Schedule LLC

Employed & LLC providers

SIHO Basic ProHealth PPO All ProHealth providers see member ID see mem

Fee Schedule card card

Silver Plan Prime ProHealth Risk ProHealth Prime PCP's, see member ID see mem

Fee Schedule Prime OB GYN's & Prime card card

SCP's

Stratose Network (formerly NPPN/Plan Basic ProHealth PPO All ProHealth providers see member ID see mem
Care America)
Fee Schedule card card

ms Inquiry Authorization In-Network Facilities Billing Hints / Notes
hone # Process Fee Schedule

alth Refer to MDwise list Community Hospitals Indy & 180 day claims filing

mer Service for provider referrals; Anderson, Howard, Westview limit.

621-7565 or otherwise, call Med (call # on ID card for add'l

344-8672 Mgmt for facilities)

authorization

mber ID see member ID card Community Hospitals Indy & WEBSITE: (www.multiplan.com)

Anderson, Howard, Westview

(call # on ID card for add'l

facilities)

mber ID see member ID card Community Hospitals Indy & 180 days Claims WEBSITE: (www.phcs.com)
Anderson, Howard, Westview filing limit.
(call # on ID card for add'l
facilities)

mber ID see member ID card Community Hospitals Indy & WEBSITE: (www.sagamorehn.com)
Anderson, Howard, Westview
(call # on ID card for add'l
facilities)

mber ID se Community Hospitals Indy & EverCare is for

Anderson, Howard, Westview dually eligible

(call # on ID card for add'l members

facilities) (Medicare/Medicaid)

mber ID see member ID card Community Hospitals Indy & 90 day Claims filing WEBSITE: (www.siho.org)
Anderson, Howard, Westview limit.
(call # on ID card for add'l
facilities)

mber ID see member ID card Community Hospitals Indy & Community Health Network Employee
Anderson, Howard, Westview Benefit Plan
(call # on ID card for add'l
facilities)

mber ID see member ID card Community Hospitals Indy & WEBSITE: (www.coalitionamerica.com)
Anderson, Howard, Westview Do not enroll Mid-Levels
(call # on ID card for add'l
facilities)

Plan Name Type of Plan Fee Participating Claims Claim
Schedule Providers Address Ph
United Healthcare
USA MCO Community United CHI/CHA Employed & see member ID see mem
USA MCO & Compensation LLC card card
Hospital Healthcare providers

Employed & LLC

Basic ProHealth PPO ProHealth providers see member ID see mem
card card

Workers ProHealth Optional for ALL see member ID see mem
Comp.
Workers Comp providers. One agreement card card

for all 4 plans.

ms Inquiry Authorization In-Network Facilities Billing Hints / Notes
hone # Process Fee Schedule

mber ID see member ID card Community Hospitals Indy & 90 day claims filing WEBSITE: (www.uhc.com)
mber ID Anderson, Howard, Westview limit.
mber ID (call # on ID card for add'l
facilities)

see member ID card Community Hospitals Indy & WEBSITE: (www.usamco.com)
Anderson, Howard, Westview
(call # on ID card for add'l
facilities)

see member ID card Community Hospitals Indy & WEBSITE: (www.usamco.com)
Anderson, Howard, Westview Agreement includes Corvel, First
(call # on ID card for add'l Health,USA/MCO and Encore Work Comp
facilities) Plans.