YesCare Claims

Yes. Authorization for specific services will be obtained by the correctional institution before the inmate is scheduled for his or her appointment. When the appointment is made, the correctional institution should provide an authorization number for your records. Any questions regarding the authorization should be directed to the medical staff at the referring correctional institution. When the inmate arrives for an appointment, the correctional officer should provide an authorization letter to you. If you do not receive the authorization letter at the time of the appointment, contact the correctional institution from which the patient has been referred. Services must be authorized before the claim is processed and payment can be made; however, authorization does not always guarantee payment. Please place the authorization number on the claim form in box 23 of the CMS 1500 and box 63 of the UB-04.

Claims for services should be submitted within 60 days (unless otherwise specified in any agreement you may have with YesCare Health) from the date of service to the following addresses to ensure timely filing and prompt payment: Claims for services should be submitted electronically via Availity. Payer ID: 43160 Claims can be emailed to claimsupload@yescarecorp.com or faxed to: 629-333-7301 (Important note: Sending claims to the correctional institution or any other address will delay the processing and reimbursement and could potentially result in lost claims and non-payment of services.) Claim submissions should be in accordance with AMA, ADA and CMS guidelines for billing. Claims should be submitted on the CMS 1500 or UB 04 form. The form should be completed to the same extent as they are with Medicare. The patient address, as well as the insured’s address will be the correctional institution address. The payer name will be YesCare Health. Non-contracted providers that have not previously submitted a claim to YesCare Health should include a completed W9 form with their first claims submission. The W9 is necessary to ensure that the correct remit address and tax identification number are entered into the YesCare Health system so the claim can be processed, and timely payment can be received.

Status of a submitted claim can be obtained 24/7 through our YesCare Provider Portal. Use the link http://providerportal.yescarecorp.com Questions regarding the status of a submitted claim can be directed to: claims@yescarecorp.com Please include; Provider’s Tax Identification Number Inmate full name Date of Service Amount of the claim

Questions regarding the reimbursement received on a claim should be directed to: claims@yescarecorp.com If the provider feels their claim has not processed correctly, they should submit an initial appeal in writing no later than forty-five (45) days following the receipt of the payment or denial. The initial grievance should detail the date(s) of service, patient name, amount paid and the details of the dispute. The appeal should be emailed to: claimsappeals@yescarecorp.com The appeal will be investigated and a response given within forty-five (45) days. If payment or denial is accepted and no appeal is filed within the forty-five (45) days following the payment or denial, YesCare considers the matter to be final. YesCare reimburses non-contracted providers at rates similar to state and federally funded payers.

YesCare patients are incarcerated at the time of service; therefore, providers shall make no attempts to obtain additional payment from the patients for services that YesCare is responsible for or has already paid the provider. The fees paid by YesCare represent payment in full for services rendered. YesCare may be secondary payer for services rendered for motor vehicle accidents, product recalls or group coverage. Under no circumstances should Medicare or Medicaid be billed for an inmate’s care with exception of some inpatient services provided in states with specific statutes allowing Medicaid as primary payer. The inmate’s paperwork or the medical staff at the facility will assist providers in identifying services that fall into either of these two categories. All clinical information, including recommendations for additional services and follow-up appointment(s), should be supplied to the correctional officer accompanying the patient or to the medical staff at the referring correctional institution, never to the patient. Any additional patient information that may be needed can be obtained by contacting the medical staff at the referring correctional institute.