Providers for CCP Employee Plans - Claims Information


Providers shall submit claims in accordance with applicable state and federal laws. Unless otherwise stated in the Provider Agreement, the following guidelines apply:
 

  • Providers should submit all claims within 60 days of the date of service.
 
  • Claims submitted after a 180-day period from the date of service will automatically be denied by CCP for untimely filing.
 
  • Providers shall submit clean, complete, and accurate claims to CCP or its designated clearinghouse, via an 837 HIPAA compliant electronic media format. Provider agrees to work with CCP contracted clearinghouses. The advantages of electronic claims submission include, but are not limited to increased speed of payments, reduced data entry errors, less paper, and decreased clerical costs.
 
  • If you are currently submitting paper claims to CCP or using a clearing house that is unable or unwilling to submit claims electronically to CCP’s clearing house, you have options available to you that will allow you to save time and money send electronic claims today!

Electronic Claims Options

 

CCP and Availity partnered to offer free claim and Electronic Remittance Advice (ERA) options. We are excited to offer an enhanced free claim direct data entry option and ERA portal for your use. These are entirely sponsored by CCP, at no cost to you. These options enable providers to conduct business with CCP using the following methods:
 

  • Enter and submit claims, receive ERA, and exchange other electronic transactions using a browser-based application over the Internet.
 
  • Directly transmit HIPAA compliant ANSI transactions over a secure direct connection.
 
  • If you are currently registered with Availity, click here to access the Availity Portal for CCP.

Providers may also submit claims that require attachments via paper. All paper claim forms must be complete and accurate containing all data fields necessary for the claim to be considered clean.

Electronic Claims Registration

www.availity.com or 1-800-282-4548

Electronic Funds Transfer (EFT) Registration

EFT Request Form

Claim Submission Timeframe

180 days from date of service

Third Party Liability

It is the provider’s responsibility to notify CCP if a member has coverage in addition to the CCP Employee Plan coverage.

Electronic Claims Filing

Availity Payor ID: 59064

Paper Claim with Attachment Submissions

Community Care Plan - CCP Employee Plan Claims PO Box 841209 Pembroke Pines, FL 33084

Claim Inquiries

Check claim status electronically with our provider portal, PlanLink, or call 954-622-3499. For information about PlanLink, click here.

Claim Appeals

Electronic Claim Appeals:
Participating providers with PlanLink provider portal access can submit claim appeals electronically. For more information, send an email to PlanLink@ccpcares.org
 

Paper Claim Appeals:
Paper Claim Appeals must be mailed to CCP using the CCP Request For Reconsideration Form along with a copy of the claim form:
 

Community Care Plan - CCP Employee Plan Claims Provider/ Claims Appeals PO Box 841209 Pembroke Pines, FL 33084

Copayments

Copay information is available via PlanLink. From the PlanLink Home Screen:

  • Click on the “CCP Benefit Summary Documents” link
  • Select the indicated CCP Employee Plan Schedule of Benefits document.