ID Card Requirements

CHA must approve a sample of the identification card prior to printing. Both front and back of the identification cards need to be submitted for approval. CHA’s appropriate logo must appear on the front of the card in block letters, preferably on the right hand corner of the card.

Additional Requirements

• Payor and/or Employer Name
• CHA’s Member Service Number (574) 647-1820 and (888) 689-2242
• Utilization Review Number
• Pre-Certification Requirements and number
• Non-Compliance Penalties
• Co-Pay Amounts
• Payor’s Toll Free Number (Eligibility Verification)

If an affiliated network is being used, then the affiliate network’s logo MUST be represented on the card. This information can be printed on the card or stickers may be used.

If CHA is repricing claims, then CHA’s claim address, Electronic ID Number, and webpage information must appear on the card as follows:

Community Health Alliance
P. O. Box 21943
Eagen, MN 55121
EDI# 35193

If CHA is doing the Utilization Management, then CHA’s telephone numbers are printed on the reverse side of the identification card:

(800) 301-1824 and (574) 647-1824

Please note that logos for ID cards are subject to change depending on how each group is contracted and/or set up. If you have questions about logos, I.D. Cards, or phone number’s, please contact Adam Fulks at (574) 647-1840, or afulks@beaconhealthsystem.org

Sample ID Card

Front CHA/LCI Payor Name Company Name Identification Number: 12345678910 Employee Name: John Smith Group Number: 1234 Division: AX

Back To locate an in network provider contact CHA at (888) 689-2242 or www.chanetwork.com SEND CLAIMS TO Community Health Alliance P. O. Box 21943 Eagen, MN 55121 EDI# 35193 PRE-CERTIFICATION PRE-CERTIFICATION IS REQUIRED FOR IN / OUT PATIENT PROCEDURES & STAYS, HOME CARE SERVICES, EQUIPMENT AND THERAPIES. Call 1-800-301-1824 or 574-647-1824. Failure to call may result in reduced benefits.

 

Disclaimer: This information is for informational purposes only and is not intended to constitute professional advice as circumstances may vary. CHA is not liable for information contained on this site. Fee schedule information applies only to M.D.s and D.O.s, not to any other Allied or Behavioral Health providers. CPT code allowables are global and do not represent modifiers. Information contained on this website is subject to change.