Provider Quick Reference Guide

Download the Advicare Provider Quick Reference Guide

CLAIMS SUBMISSION

  • Claims must be submitted on CMS-1500or UB-04 forms
  • Claims must be filed within 365 days ofthe date of service

Billing Address

Advicare
PO Box 5547
Hauppauge, NY 11788

Phone: 1-888-781-4371
Fax: 1-646-417-5836

ELECTRONIC DATA INTERCHANGE (EDI)

Claims may be submitted to Advicare through the following clearinghouse:

  • EMDEON: PAYOR ID 45423

AUTHORIZATION GUIDELINES

Hospital Admissions

  • All elective hospital admissions require prior authorization
  • Advicare must be notified within 2 business days of emergency admissions

Outpatient Services

For Prior Authorizations – Phone: 1-888-781-4371
Care Management – Fax: 1-855-303-2427
For Pharmacy Authorization CVS Caremark – Fax: 1-888-836-0730

INFORMATION NEEDED FOR PRIOR AUTHORIZATION REQUEST

  • Member Name
  • Member ID Number
  • Name, Telephone and fax of the provider rendering service
  • Proposed date(s) of service
  • Diagnosis with ICD-9 code
  • Medical information to support request
  • Signs and symptoms
  • Past and current treatment plans (including response to treatment)
  • Medications, along with frequency and dosage

PROVIDER SERVICES

Our Provider Services staff is ready to furnish you with the necessary tools to provide the highest quality of healthcare to Advicare enrolled members.

Provider Services can help you with the following:

  • Provider Manual Questions
  • Provider Education
  • Physician and Office Staff Orientation
  • Appropriate utilization or services
  • Contracting
  • Resolve escalated provider inquiries with contract guidelines
  • Assist in keeping provider records up to date
  • Additional information can be provided by calling 1-888-781-4371

IMPORTANT TELEPHONE NUMBERS & CONTACT INFORMATION

For questions about the health plan contact member services contact: 

Member Services
Phone: 1-888-781-4371
Mon – Fri, 8:00 a.m. – 5:00 p.m.

For questions  related to Case/Disease Management Programs & Prior Authorizations contact: 

Case/Disease Management/Authorizations
Phone: 1-888-781-4371
Fax: 1-855-303-2427
Mon – Fri, 8:00 a.m. – 5:00 p.m.

For after hour notifications contact:

Nurse Response Helpline: 1-888-781-4371 (24/7 Assistance)
TTY/TDD: 1-888-357-7188 (24/7 Assistance)

Advicare Physical Address:

Advicare, Corp.
531 Main Street, Suite RL-1
Greenville, SC 29601

Official Website URL:  www.AdvicareHealth.com