Frequently Asked Questions

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Have questions about directprovider.com or other topics for your Coventry business?

That is why we included the Frequently Asked Questions section, so we could provide you with quick and simple access to the answers you need. The Q & A’s below include information from Login and setting up Administrators, to claims and eligibility, to understanding your remittance advice, and other functions of our secure provider portal. If you don’t see your question here, Contact us, or call your local Provider Relations Representative.

Administrator/Login Questions

Claims Questions

Eligibility/Benefits Questions

Remittance Advice Questions

Authorizations Questions

Other Functions Questions





How do I learn more aboutdirectprovider.com?

There are several options for learning aboutdirectprovider.com. We encourage providers who are using this online service to learn as much as they can so they can take advantage of all the online services available to them. Training includes:

  • Detailed Users’ Guide – This can be found in the help section after you have logged in or in the Resource Library
  • Help Screens – Be sure to take advantage of the help sections within Directprovider.com as they provide additional insights into the program
  • Online Webcast training – Coventry corporate training routinely conducts online group training for this service and for new functions as they are released. Check on your healthplan’s website or call your Provider Relations Representative for more information. This is an excellent way to learn the tool and find out what questions other providers are asking.

Administrator/Login Questions

We are very large and have multiple tax IDs and dozens of provider IDs. How do we set these up?

directprovider.comis flexible enough to meet your needs. YOU have the option of determining if you want to have one administrator who set up all users, or several administrators at different sites. If you are a billing office/service, you will be required to get permission to access data associated with a tax ID you do not own. Registration/setup instructions walk you through step by step during the process.

Are all Coventry Plans available?

Yes…except for the First Health Network (TPA/Carrier) business.

Can you have separate administrators for the same tax ID?

Yes. Multiple administrators can be set up for each Tax ID.

Will I need separate passwords to view the different health plans?

No, one user ID and password gets you access to all Coventry Plans.

What is the provider number and where do I get it?

The provider number is a unique number that is assigned to you by your health plan. It can be found in the upper left corner of your Coventry Remittance advice, or you request this number from your provider relations representative.

We are a non-participating facility and do not contract with a Coventry Plan, can we get access todirectprovider.com?

Yes, if you have ever filed a claim with any Coventry Health Plan, you will have a provider ID number. There is no cost even if you are not contracted with one of the Coventry plans. You can register under any Coventry provider ID, and then add additional or new Coventry health plans later.

How do I select providers for another health plan?

In the box where the provider drop down appears is an edit button. Click the edit button. From the provider edit / customization screen you can customize each tax ID for each health plan. Be sure to click “done” when you are finished making your selections.

How long is the time out before the system kicks you out for no activity?

2 hours.

Will Passwords Expire?

No. However administrators can reset passwords as needed.

Is “Provider” defined as the practice or the tax ID?

There is a tax ID for the overall group, but each provider can be looked at separately. All Provider ID numbers we have associated with each tax ID will be available.

One of the physicians is no longer with the practice and is still appearing in the drop down – how do I fix this?

Take some time to remove the physicians that you do not want appearing in your drop down by using the edit function in the provider drop down area of the portal. Customizing this list is the easiest way to weed out unwanted physician records from the list. All providers we have had associated with a tax ID can be viewed in the event you wish to look up historical information. If you see information that you believe to be incorrect, please contact your Provider Representative.

I have an issue for an inactive user post-tax ID addition. The user tried to log on and they were getting an error.

The administrator needs to add the tax IDs to all users who currently did not activate their account or that person will be locked out.

Claims Questions

How much claim history is available online?

3 years, depending on the plan.

What Medicaid Plan Information will you be able to see?

Claim Inquiry information will include claim summary, history, and detail, just as it appears for commercial plans. Member eligibility will include coverage history, PCP history and COB information if available. Remittance advices are available. However, benefit information is not available for Medicaid Members.

How will offsets and backouts be shown on the claims status?

Backout claims (these claims have a negative balance) are associated with a specific claim and will only be available by clicking or searching on the original claim associated with the backout. Claim detail gives you the option to see the original claim, backout claim, and/or replacement claim. At the top of the claim it will identify the “Claim Type”.

What is the Patient Control Number?

The patient control number is the medical record number we receive from the provider associated with the claim.

I currently see unpaid claims in addition to other statuses – is this OK?

Unpaid claims is not a claims status, it is a search option which shows all claims that do not yet have a check or EFT payment associated with it. Keep in mind that an approved status may eventually get denied or pended – it is not a guarantee of payment.

Do claims include the rejected claims from our clearinghouse, or where they are rejected from?

No, you will not be able to see claims rejected at the clearinghouse, since we would not have received it. The rejected claims you can view online are ones that are rejected by Coventry, after they passed through the clearinghouse. If you submitted your claim directly to us, without going through a clearing house, then they will all appear. Example of a rejection is “patient not found”.

Can I submit claims directly throughdirectprovider.com?

Claims submission will be available in a future release.

Why do some claims allow you to view the Remittance Advice and others do not?

It depends on who the claim was paid to. If you are viewing a claim under a provider ID that did not receive payment for that claim, then the remittance advice link will not appear with that claim. To view the remittance advice, simply look up the remittance advice under the appropriate provider ID it was paid to.

Can claim adjustments be requested online?

Yes. This service allows a provider to request that the plan to take another look at a claim based on additional information, including attachments that can be sent via directprovider.com. However, it is not a formal appeal.

I submitted a claim to the health plan, it was paid, but I cannot find it now.

Coventry internally routes claims to the correct payor, even if the claim was submitted to the incorrect health plan. If you submitted the claim to the incorrect Coventry payor ID and it cannot be found, you should check under another Coventry health plan you do business with. Also, review your remittance advice for any information on the re-routed claim. The Internal Claims routing project for Coventry is a staged deployment that will include all Coventry health plans/payer ID’s by May 2009.

Eligibility/Benefits Questions

If you put in a subscriber, will you see the dependents?

Yes, dependent information will appear in eligibility. A dependent’s detail can be found by clicking the dependent.

Willdirectprovider.comhave an "avenue" for optometric practices to get eligibility info such as last eye exam; last frame; last lenses?

It depends on whether the benefit is a carve-out, a rider, or exclusion. If the coverage category is a carve-out, the response will request that you call Member Services. Since it is not the same for all products or plans, availability of this benefit information will be hit or miss.

Can I authorize a patient to be able to choose one of our physicians as a PCP if we now have a closed panel?

No, members are the only ones that can change their PCP. Providers do not have the ability to do that nor is there anywhere they can identify themselves as an open or closed panel for just one patient.

Is there a ‘general’ coverage category to simply view overall eligibility rather than having to look under each coverage category?

Yes. There is a default coverage category called “general eligibility”. However, for any coverage category, the response will contain overall eligibility at the top of the screen. Note the “help” section provides clear information on how to read benefits online.

Customize your categories – what is that for, and why would I need it if at the top of every page the general eligibility displays?

Using a specific coverage category would allow you to view benefit limits and guidelines for that specific benefit type – for example, you could get a copay specific to infertility testing.

Can I narrow the coverage category drop down list? It contains a lot of stuff I won’t ever look at?

Yes, you can edit the list and remove those categories that you wouldn’t use by clicking “Customize Your Coverage Categories” below the coverage category field.

Is the PCP History function available in for a newly termed member?

Yes.

Remittance Advice Questions

We are not able to receive electronic remittance advices (ERAs) but want electronic funds transfer payments (EFTs). Can I pull in remittance advices (RAs) without patient information?

Yes, there are several ways to look up RAs, including service dates, payment dates, or payment number (EFT, check number). You will also find a link directly to an RA when viewing a paid claim.

Can I stop receiving paper remittance advices since I can now obtain them online?

Yes, Simply notify your Provider Relation Representative and they can stop paper remittances from arriving in the mail.

I searched for an RA using a specific doctor’s name and could not find it.

You must search for remittances using the provider number who received payment for that claim. If the claim is paid to the “vendor," search using that provider number, If the claim is paid to the “master vendor," search using that provider number.

How long does it take for the RA to be available online?

24 hours after the check/EFT is created. There are limited occasions where the health plan can hold up a remittance advice for more than 24 hours.

Authorizations Questions

Can I submit an authorization online?

Yes, depending on the health plan you are submitting for. Additional health plans will be released at future dates.

Can I lookup an authorization online?

Yes, Authorizations can be searched in a variety of ways. They are available immediately. You will need to be somehow associated with the authorization, either as the requesting provider or the service provider.

We sometimes need to update our Authorizations, is that possible?

Yes, authorizations can be updated by either the requesting or service provider.

What other authorization functions are available?

Providers have the ability to request a reconsideration of a denial or, if you are not satisfied with the decision, request a first level, non urgent appeal online.

Do we request urgent authorization online?

No, provide the service if it is a matter or life or limb. You always have the option of calling the health plan directly.

How do I know what procedures require an authorization?

Authorization information can be found in the Resource Library. If you cannot find what you are looking for there, call the health plan.

Other Functions Questions

What is the turnaround time in “contact us”?

We typically respond within 2-3 business days; however we allow ourselves up to 30 days to respond to electronic inquiries.

Can I check the status of a credentialing application that is in process for one of our physicians?

This is not currently available. It will possibly be available in future enhancements.

Can I look up medical criteria and technology assessments by procedure code?

Yes. The search function allows you to search the Resource Library using any terms you wish. Searches are done through the titles and the body of the documents online.

Are forms available online?

Yes. Forms can be found in the Resource Library.

Will a provider be able to send a secure message to a Provider Representative, or someone specific within the organization?

No. However, messages are sent to a central location and are forwarded to the appropriate department or individual.

How far back can I find member ID cards?

Only current member ID cards are available in directprovider.com. If you cannot find a member ID card, online, please call the health plan.


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