Claims


Below you'll find claims information for the BadgerCare Plus and Individual and Family plans, along with information on the National Correct Coding Initiative. 

BadgerCare Claims


Claims Submissions

  • CCHP does not accept faxes for claims.
  • All claims must have the providers’ NPI numbers and taxonomy codes on their claims. If the taxonomy on your claim is different than what is registered with the state, your claim will reject.
  • CCHP NPI and Taxonomy Billing Requirement Guide
  • CCHP Taxonomy Quick Reference Guide
  • Chorus Community Health Plans asks that providers allow 45 days to pass from the date of the submission before calling to check the status of claims.


Claims Mailing Address

Chorus Community Health Plans
P.O Box 56099
Madison, WI 53705


Submitting Corrected Claims

To allow our system to read and acknowledge corrected claims, please follow the instructions in CCHP’s Corrected Claim Submittal Guide.


CCHP Provider Appeals Process

We no longer accept paper appeals and will return paper appeals to providers instructing providers to submit appeals via the portal. Portal access and information can be found on our website at chorushealthplans.org. To submit appeals via the portal:

  1. Select "Providers," then provider portal in the dropdown.
  2. Choose Badgercare Plus Claims Look-Up Tool and select “sign up.” The Registration guide and user guide can also be found on the portal page.

**Please note: Administrators will be responsible for setting up their organizations prior to individual providers registering. Once Chorus Community Health Plans approves the administrator they can then have their individual providers register. The administrators will be responsible for approving their individual providers. Individual providers will not have access until their administrator approves.

If you have any questions, please send a detailed email with your user name, NPI number, and tax ID number to: CCHPProviderRelations@ChorusHealthPlans.org.


Electronic Claims Submission

  • Providers are encouraged to submit claims electronically.
  • EDI Payer number is 39113
  • Manually Key in claims and submit electronically through Smart Data Stream Clearing House Portal


Questions?

Questions For questions regarding claims and claims payments, please contact CCHP Customer Service at 800-482-8010.

For questions or problems with auto authorizations, call CCHP Clinical Services department at 414-266-5707 or 877-227-1142, option 2.



Individual and Family Plan Claims


Paper Claims

CCHP does not accept faxes for claims. Hand-written claims are also not accepted.

Paper Claims can be mailed to:
Chorus Community Health Plans
P.O. Box 106013
Pittsburgh, PA 15230-6013

Electronic Claims

You may file claims electronically through the vendor of your choosing.

Documents cannot be attached when sending claims electronically.

EDI Payer number is: 251CC

Electronic Remittance Advice (ERA) and Electronic Fund Transfers (EFT) forms are available on the website.


Corrected Claims

  • CMS 1500 should be stamped as a corrected claim.
  • UB04: Corrected claims should be billed with the correct bill type.


Claims Appeals

CCHP does not accept claims or appeals via fax.

For questions regarding claims and Explanation of Payment (EOP), providers can chat online through the portal or contact:

Individual and Family Plans Provider Service
844-202-0117

After contacting customer service, please complete the Individual and Family Plan Provider Appeal / Claim Request Review Form.

Submit the form, along with copies of any supporting documentation to:
Chorus Community Health Plans
ATTN: Appeals Department
P.O. Box 1997, MS 6280
Milwaukee, WI 53201-1997


National Correct Coding Initiative

CCHP follows the National Correct Coding Initiative (NCCI) which was created by the Centers for Medicare and Medicaid. This initiative was created to stop improper coding which leads to incorrect payments.

Forward Health has implemented the NCCI to monitor all professional claims and outpatient hospital claims submitted with Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) for compliance with:

  • MUE (Medically Unlikely Edits), or units-of-service detail edits.
  • Procedure-to-Procedure detail edits.

MUE is the maximum units of service that a provider would claim for a single member on a single date of service for each code. Procedure-to-Procedure detail edits define pairs of codes that should not be claimed together on the same date of service.

If the claim is denied for either of these reasons, providers will receive an explanation of benefits on the remittance advice that it was denied because of NCCI.

Learn more here.