Support for Network Providers

Yes. If you submitted your request using our online tool, you can check application status.

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. Depending on the nature of the error, you will be able to do this during either the credentialing verification process or through Claritev’s appeal process outlined in the Network Handbook.

Yes, practitioners have a right to review the 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.

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. To apply to join our networks, these forms must be accompanied by a completed and signed Claritev provider contract.

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.

For patient benefit information, please contact the patient’s insurance company, human resources representative, or health plan administrator directly. The telephone number can usually be found on the back of the patient’s ID card.

For claims questions or to request claim forms, please contact the patient’s insurance company, human resources representative, or health plan administrator directly. The telephone number can usually be found on the back of the patient’s ID card.

There are two ways to submit a claim:

1. By mail to the address found on the patient’s ID card using a CMS-1500 or UB92 claim form (or successor form).
2. Electronically through transaction networks and clearinghouses using Electronic Data Interchange (EDI). This method promotes faster, more accurate processing than paper claims submitted by mail and is required for federal benefit plans.

For additional EDI information, please refer to the patient’s ID card to obtain the payer identification number of the clearinghouse used for claims submission.

If a specific problem arises, please contact the claim payer’s customer service department listed on the patient’s ID card or on the Explanation of Benefits (EOB) statement.

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 submit a request online. If the issue can’t be resolved, it will be escalated to a provider service representative. On average, escalated issues are resolved in less than five business days.

Healthcare providers are required to include their NPIs, if assigned, on all applicable electronic claims as mandated by the Health Insurance Portability and Accountability Act (HIPAA). Covered Entities such as healthcare payers are required to identify a provider using their NPI on all electronic claims and may reject an electronic claim that does not contain such NPI. Although not yet required on paper claims, we recommend inclusion to facilitate processing.

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.

You may obtain a copy of your fee schedule online via our provider portal.

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/or case management firms.

Our client lists are now available in our online Provider Portal. To get started, go to the Provider Portal and 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 homepage or under Help and Resources. A user guide is also available within the portal.

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.

Clients whose plan members have access to our networks are required to display a Claritev authorized name and/or logo on member ID cards and the Claritev authorized name and/or logo on the Explanation of Benefits (EOB) statement.

We periodically use our internal call center to verify provider information via outbound telephone calls. Representatives will always identify themselves as calling from Claritev and primarily verify information we have on file, such as your tax ID number (TIN) or service address, to help support claims processing for our clients and their health plan members. If a call is not answered, they will leave a callback number: 866-331-6256.

Should you experience difficulties with a particular payer during your participation in our network, we will work closely with you and the payer to resolve any issue. Our contractors, customer service professionals, and account managers work as a team to liaise between Claritev payers and providers. This helps us ensure that claims payment and contract administration are handled efficiently and effectively. You can be assured that we do all we can to keep the relationship between two of our most important constituencies — Claritev payers and providers — healthy and effective.

Claritev recommends that you always call to verify eligibility and to confirm whether precertification and/or authorization for services are required. The number to call will be on the back of the patient’s ID card.

Send your completed HCFA 1500 or UB 04 (or successor form) with your billed charges to the claims remittance address indicated on the patient’s ID card. Please do not send your completed claim form to Claritev.

Typically, you should receive your payment within 30 business days after the claims payer has received a completed HCFA 1500 (or successor form) containing all information reasonably required by such payer, subject to applicable federal or state laws and your applicable participating provider agreement(s).

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.

You should always verify eligibility when presented with an identification card showing a Claritev authorized name and/or logo, just as you would with any other patients. You also should collect any co-payment, co-insurance, and/or deductible, if applicable, at the time of service and then submit a clean claim to the payer in a timely manner by following the instructions on the back of the patient’s ID card.

To become a ValuePoint provider, send an e-mail to [email protected].