Claims

 

Providers must submit Claims for processing in a HIPAA-compliant 837 file format and file electronically with Availity at using the Doctors Health Care Plans, Inc. payer ID DRHCP. If unable to submit electronically, physicians and other healthcare providers can submit professional claims on a properly completed CMS 1500 form within the time frame specified in their contracts or by CMS. Providers may use the revised 1500 claim form (version 02/12). This approved updated 1500 claim form accommodates reporting needs for ICD-10 and aligns with requirements in the Accredited Standards Committee X12 (ASC X12) Health Care Claim: Professional (837P) Version 5010 Technical Report Type 3.If unable to submit facility claims electronically, physicians/providers can submit them on a properly completed UB-04/CMS 1450 form within the time frame specified in their contracts or by CMS. If all electronic data interchange (EDI) methods have failed, and the provider has already contacted his or her Doctors HealthCare Plans provider services executive for assistance, then the paper claim submission and claim-related correspondence should be mailed to the following address:

Doctors HealthCare Plans, Inc.
ATTN: Claims Department
BOX 132
1825 Ponce De Leon Blvd
Coral Gables, FL 33134

Not submitting a clean, properly completed claim will delay processing. Doctors HealthCare Plans, Inc. contracted provider filing limitation is generally 90 (please refer to your provider agreement as this could vary) days from the date of service or the through date of service listed on the claim form, whichever is the later date. The noncontracted provider filing limitation is 12 months from the date of service or the through date of service listed on the claim form, whichever is the later date.

How to Provide Additional Claim Information

Providing additional information requested on a claim can be done via our website or by mailing information to us. 

• To securely send information via website CLICK HERE
• You can also mail information with the letter received to: 
  • Doctors HealthCare Plans, Inc.
    BOX 132
    1825 Ponce De Leon Blvd
    Coral Gables, FL 33134

Electronic Funds Transfer Information

One of the many benefits of being a Doctors HealthCare Plans Provider is the option to enroll in our Electronic Funds Transfer (EFT) program through RedCard Systems which is provided free of charge to you.

To begin receiving EFT payments from Doctors HealthCare Plans, Inc. it is important that you follow the instructions below. Otherwise, you will continue receiving paper checks and remittance advices.

Instructions:

1. Go to: https://enroll.ach835.com/new (DO NOT ADD “” before the URL when you type it in your browser.)
2. Enter all requested fields on the Enrollment See the attached Enrollment Screen on page 2.

NOTE: Do NOT fill out the NPI field.

3. You will receive a Welcome Email with a link to the enrollment page and login credentials, as well as additional instructions for completing your

The benefits to enrolling with RedCard EFT include:

• Less paper to handle in-house
• Receive payments quickly through ACH direct deposit
• Increases efficiency in capitation reconciliation

If you have questions, please email RedCard Systems at support@ach835.com, or call the RedCard Provider Service Center at (844) 292-4066. You can also reach Doctors HealthCare Plans Provider Relations Department at (305)422-9300 Option 2.

 

 

H4140_PROVRELEFT_C
Last Updated:  09/24/2021