Claims

Information and instructions for submitting claims to InnovAge

In addition to coordinating and providing care to individuals enrolled in InnovAge's Program of All-inclusive Care for the Elderly (PACE), InnovAge also processes and pays health benefits for our provided by outside providers.

Requirements
Benefits are subject to the participant’s current active enrollment and eligibility and this statement of benefits is not a guarantee of payment. All services should be coordinated and authorized by the interdisciplinary team, except emergency care. If applicable, the outside provider will receive a consultation request form at the time of the visit, which must be returned to the participant’s PACE center clinic. All non-emergency services must be authorized by InnovAge before services are rendered. Providers who render emergency services must notify InnovAge PACE within 24 hours of or the next business day after that service has been rendered.

Submitting Claims via EDI
InnovAge’s preferred method for claims submission is EDI. Optum (formerly Change Healthcare) is our current Clearinghouse provider, and we are listed under TCC (Total Community Care).

Optum Electronic Data Interchange Payer Number: 31182

Eligibility and Claims Status requests should be submitted electronically through Optum, InnovAge’s EDI Provider. Submit these requests directly through your Clearinghouse, or reach out to Optum to become setup directly.

Billing for services rendered to InnovAge PACE participants must be submitted to via one of the following CMS Standard claim forms: CMS-1500 (HCFA-1500) for Professional Services; or UB04 (CMS 1450) claim form for Institutional Services; or ADA Dental form. If you need assistance completing a CMS claim form, please call the Claims Direct Phone Line at 720-382-7015 or 855-542-7622.

Claims shall include all participants’ identification information and itemization of services provided.

Payment
InnovAge shall have no obligation to pay contracted providers for services billed more than the lesser of 120 days after the date on which services were rendered or the minimum period required by applicable state law. InnovAge has a timely filing period for payment reconsideration/ appeal of 120 days from the date of payment.

Claims Phone Line

For Paper Claims Status/Eligibility information only call our claims team at 720-382-7015 or 855-542-7622. EDI Providers must submit for information electronically.

Paper Claims
Due to the high number of claims processed by InnovAge, our preferred method of claims submission is via EDI - please see information above. If paper claims must be submitted, they can be sent to:
InnovAge PACE
Claims Processing 
PO Box 21931 
Eagan, MN 55121

Providers are highly encouraged to use a trackable mailing method such as USPS Priority Mail when sending documents to this address. This will allow for the package to be tracked and provide proof of timely claim submission.

Acceptance of Payment
Outside providers must accept payment from InnovAge as payment in full, and may not bill participants, CMS, the state Medicaid agency, or private insurers, and must agree to hold harmless CMS, the state, and participants if InnovAge does not pay for services performed.

More Information
Outside providers can find more information in their state-specific Provider Manual.   

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