How can I add an Advanced Practice Provider (APP’s) to our Kids Health First payor contracts?
Please go to the Credentialing page on the KHF intranet for instructions:
KHF can add APPs to applicable payor contracts after the credentialing process has been completed.
APPs should also enroll in the Georgia Medicaid program on the Georgia Department of Community Health website.
Please use this link to apply for a Medicaid number and opt-in for CMO participation.
How does our practice contract with Anthem and CareSource?
The Anthem and CareSource contracts are through The Childrens Care Network (TCCN). To begin credentialing, please contact your named TCCN Provider Relations Representative.
Does KHF help with contracts, credentialing, and claim issues with Amerigroup?
KHF does not hold a contract with Amerigroup. You will need to contact them on your own to participate with this payor.
KHF can provide basic advice on how to solve problems with Amerigroup. For anything else, a practice must call Amerigroup’s provider relations customer service and ask to speak with its local representative. Beyond general advice, KHF practices are to resolve Amerigroup issues with their local representative and by calling the payor’s provider relations customer service number.
Can a practice appeal an unfavorable claims outcome?
A practice has the right to dispute and appeal claims after getting an unfavorable outcome. The practice can submit as many reconsiderations or appeals, as needed to resolve a dispute or claim.
Practices are encouraged to follow payors’ dispute and appeal processes. It is particularly important that a practice follows the required appeal process as listed out by the payor.
KHF suggests that practices contact KHF’s provider relations team for help. We will work with the payor to help you with the issue.
Does KHF participate in all plans within our contracted payors?
No.
There are several payors that administer plans as third-party administrators.
There are also several companies that have built their own network. These types of plans are often in relationships with healthcare systems, unions, and self-funded groups.
Staff should not rely on a payor logo found on the patient’s ID card to determine if a practice participates with a certain payor.
Please have your staff verify benefits and, if in doubt, call the payor.
Always obtain and save all reference numbers when speaking with a payor by phone or through the provider portal.
