Healthcare Provider FAQs
Application requests / status
I submitted an application to join your network. Can I check the status?
Yes, if you submitted your request using our online tool, you can Check Application Status
How can I correct erroneous information that was submitted on/with my application?
You have the right to correct any erroneous information submitted by you or other sources to support your credentialing network application. If Claritev becomes aware of any discrepancies with your application for network participation, you will be notified of the discrepancy and given an opportunity to correct erroneous information during either the credentialing verification process or through Claritev’s appeal process outlined in the Network Handbook, depending on the nature of the error.
I submitted a credentialing/recredentialing application to your network. Can I have access to and review the credentialing/recredentialing information your network obtained to evaluate my application?
Yes, practitioners have a right to review the credentialing/recredentialing information obtained during the credentialing/recredentialing process with the exception of peer-review protected information. For details on how you can obtain this credentialing/recredentialing information, you can submit a request online.
Can I use my state's credentialing form to join your network?
Providers in certain states may use their state’s form in place of the Claritev form for initial credentialing when applying to join our networks or for recredentialing purposes. We have the forms posted here for your convenience. (Note that to apply to join our networks, these forms must be accompanied by a completed and signed Claritev provider contract.)
Where can I find contracting provisions for my state?
If required by your state, certain provisions are included in your contract, as set out in the State Law Coordinating Provision (SLCP) exhibit. Periodically, we make modifications to the SLCP exhibit to reflect changes in state law. To see our current SLCP exhibits, please click here.
Benefits
As a provider, how can I check patient benefits information?
For patient benefit information, you will need to contact your patient’s insurance company, human resources representative or health plan administrator directly. That telephone number can usually be found on the back of the patient’s ID card.
Claims
How do I obtain claim forms?
For claims questions and/or forms, contact your patient’s insurance company, human resources representative or health plan administrator directly. That telephone number can usually be found on the back of the patient’s ID card.
How do I submit a claim?
There are two ways to submit a claim.
- By mail to the address found on the patient’s ID card using a CMS-1500 or UB92 claim form.
- Electronically through transaction networks and clearinghouses in a process known as Electronic Data Interchange (EDI). This method promotes faster, more accurate processing than with paper claims that are submitted by mail and is a requirement for federal benefit plans.
For additional EDI information, please refer to the patient’s ID card to obtain the payor identification number of the clearinghouse used for claims submission.
What if I have a claims payment problem?
If a specific problem arises, please contact the claims payer’s customer service department listed on the patient’s ID card or on the Explanation of Benefits (EOB) statement.
How does Claritev handle problem resolution?
When a problem arises, you should contact our Service Operations department as soon as possible, as required by your contract, to provide all information pertinent to the problem. You can request service online. If the issue can’t be resolved immediately, it will be escalated to a provider service representative. Escalated issues are resolved in less than five business days on average.
Does Claritev require me to provide a National Provider Identifier (NPI) on claims?
While Claritev does not require National Provider Identifier (NPI), providers are required to include their NPI on all electronic claims as mandated by the Health Insurance Portability and Accountability Act (HIPAA). Claims payers and clearinghouses, both of which are required to recognize only a provider’s NPI as the provider identifier on all electronic claims, may reject electronic claims that do not contain the provider’s NPI. Although not yet required on paper claims, we recommend that providers include NPI on all paper claims to facilitate processing.
Contract copy requests
How may I get a copy of my contract?
You can request it online or submit your request on letterhead with the contract holder’s signature via fax at 888-850-7604 or via mail to Claritev, Attn: Contract Requests, 16 Crosby Drive, Bedford, MA 01730.
Fee schedule requests
How can we get a copy of our fee schedule?
You may obtain a copy of your fee schedule online via our provider portal.
Client list requests
Who are your clients?
Our clients include a diverse base of insurance carriers, self-insured employers, labor management plans and governmental agencies. Many employers also use the PHCS and/or MultiPlan networks through third-party administrators (TPAs), HMOs, UR and case management firms.
How may I obtain a list of payors who utilize your network?
Our client lists are now available in our online Provider Portal. To get started go to the Provider Portal, choose Click here if you do not have an account. Once you log in, you will see the client lists in the lower left of the home page or under Help and Resources. A user guide is also available within the portal.
Termination
How can I terminate my participation in the PHCS Network and/or the MultiPlan Network?
Submit your request on letterhead with the contract holder’s signature via fax at 781-487-8273, via email at [email protected] or via mail to Claritev, Attn: Registrar, 16 Crosby Drive, Bedford, MA 01730.
About Claritev
How do I identify patients?
Clients whose plan members have access to our networks are required to utilize a MultiPlan and/or PHCS logo on member ID cards and the MultiPlan and/or PHCS name and/or logo on the Explanation of Benefits (EOB) statement.
I received a call from someone at Claritev trying to verify my information. Was the call legitimate?
Claritev periodically uses our internal call center to verify provider data via outbound telephone calls. The representatives making these calls will always identify themselves as being from Claritev. They are primarily trying to verify information we have on file, such as TIN or service address, which will help us process healthcare claims/bills on behalf of our clients and their health plan members. The call back number they leave if they do not reach a live person is 866-331-6256.
Payment
How do you handle payment issues?
Should you experience difficulties with a particular payor during your participation in our Network, we will work closely with you and the payor to resolve any issue. Our contractors, Customer Service Professionals and Account Managers work as a team to liaise between Claritev payors and providers. This helps us to ensure that claims payment and contract administration are handled efficiently and effectively. The team is also responsible for adhering to all guidelines and requirements necessary to comply with HIPAA regulations. You can be assured that we do all we can to keep the relationship between our two most important constituencies – Claritev payors and providers – healthy and effective.
How do I handle pre-certification and/or authorization and inquire about UR and case management procedures for PHCS and/or MultiPlan patients?
Claritev recommends that you always call to verify eligibility and to confirm if pre-certification and/or authorization for services are required. The number to call will be on the back of the patient’s healthcare ID card.
Where do I send claims for payment?
Send your completed HCFA or UB claim form with your regular billed charges to the claims remittance address indicated on the patient’s ID card. Please do not send your completed claim form to Claritev.
How long should it take before I get paid for my services?
You should receive your payment within 30 business days after the patient’s claims payer has received a completed legible claim, as required of our clients by our participating provider agreements.
Participation
How do you direct members to my practice/facility?
Claritev uses a variety of steerage techniques including the online searchable database, downloadable directories and direct links from our clients’ websites. We also assist our clients in creating member educational materials.
What are my responsibilities in accepting patients?
You should always verify eligibility when presented with an identification card showing a PHCS and/or MultiPlan network logo, just as you would with any other patient. You should also collect a co-payment if applicable, at the time of service and then submit a clean claim to the payer in a timely manner following the instructions on the back of the patient’s healthcare ID card.
How do I become a part of the ValuePoint by Claritev access card network?
To become a ValuePoint by Claritev provider, send an e-mail to [email protected].
How do I apply for a Rural Health Grant?
If you are a rural hospital participating in the MultiPlan or PHCS Network, you may submit an application for a grant. Applications are sent by mail, and also posted on our website, usually in the summer.
How can my facility receive a Toy Car for pediatric patients?
If you are a hospital with a pediatric unit and would like to submit a request for your facility to receive a toy car, please contact your regional network representative.
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Contact us
- Use our online Provider Portal or call 1-800-950-7040
- Medicare Advantage or Medicaid call 1-866-971-7427
- Visit our other websites for Medicaid and Medicare Advantage
