The Network Services Department is available to assist practitioners and facilities that provide service to our members. This section provides helpful information, newsletters, and forms.
Network News is published by Capital Health Plan Network Services. It has timely information relevant to your practice and your relationship with CHP. Network News can be accessed through CHPConnect.
Electronic Claims Submission
CHP currently accepts electronic claims submission from three Clearinghouses: EmDeon, Gateway, and Availity. Our Payer ID number is 95112. You will need to follow the submission guidelines in our EDI Companion Guide. Prior to submission of your initial file you must notify CHP of your intention to transition to electronic submission. You can fax the Electronic Claim Submission Enrollment form to Network Services at (850) 523-7351 or call us at (850) 523-7361. The notification will provide us with enough information to verify receipt of your initial file.
We also offer direct data entry of claims through CHPConnect. Through CHPConnect you are able to enter your claims data on an individual basis and eliminate paper submission. You will need to have access in order to use this functionality. Please go to the CHPConnect page to register.
PaySpan is health care's leading provider of payment reimbursement solutions. The PaySpan network connects over 700 health plans with over 1.3 million provider payees and 107 million consumers. With the largest health care network in the U.S., PaySpan provides payment automation services that improve administrative efficiency, meet regulatory requirements, and allow providers to manage their reimbursements.
CHP has partnered with PaySpan to provide claim reimbursement and remittance advice for our providers. This free service electronically deposits CHP provider reimbursement payments to the bank account(s) of your choice via electronic funds transfer (EFT) and provides online access to Explanation of Benefits (EOBs) and payment reconciliation reports.
Follow the instructions below to set your practice up for PaySpan's direct deposit:
- Register for your unique PaySpan registration code(s) online.
- Register for your unique PaySpan registration code(s) via email with Provider Support.
- Please use subject line "Registration Code Request - Capital Health" and include the Tax Identification Number for your practice in the body of the email. Your payments will be received via mail until you enroll in EFT.
- Once you receive your unique PaySpan registration code(s), you can then enroll in EFT.
For additional assistance, please visit PaySpan Support, email PaySpan Support directly, or call 877-331-7154 option 1.
Credentialing of Network Providers
Capital Health Plan is committed to providing our members in Leon and the surrounding counties with high-quality affordable health care. CHP verifies each practitioner's or provider’s credentials to assess their ability to deliver care to our members based on criteria that include licensure, relevant training, conduct, and experience.
Initial credentialing is completed upon acceptance to be a part of the CHP network and re-credentialing is completed every three years thereafter.
Practitioners have specific rights related to the credentialing process:
- You have the right to be informed of the status of your credentialing application.
- You have the right to review information obtained through the verification process, although this does not apply to references, recommendations, or other information that is peer-review protected.
- You have the right to clarify or correct information on your application that is inconsistent with information obtained via primary source verification. CHP’s Network Services staff will contact you in writing if they identify an inconsistency in the information received through primary source verification. To clarify or correct information in your credentialing file, submit the correction in writing to CHP’s Network Services Manager within 10 business days from the date you viewed the information. CHP will review your submission and respond in writing within 30 days of receipt.
If you should have questions regarding the credentialing process or the status of your application, you can contact Network Services at (850) 523-7361 or by emailing Network Services directly. CHP will provide you with status within 10 business days.