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Claims & Eligibility Provider Portal. This portal is a quick, convenient, and secure way to verify member eligibility, review claims status, submit claims inquiry request and much more. The portal is available 24 hours a day, 7 days a week.
Download Full PDF. The Provider Manual covers the following Plans: VillageCareMAX Managed Long-Term Care (MLTC) VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP) VillageCareMAX Medicare Health Advantage FLEX Plan (HMO D-SNP) VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP)
VillageCareMAX MLTC is a Managed Long-term Care (MLTC) Plan covers certain long-term care benefits such as: In-Home Care; Medical Supplies and Equipment; Personal Emergency Response System (PERS) Dental, Eye and Foot care; Adult Day Health; Consumer Directed Personal; Assistance Services (CDPAS)
In addition, VCM is working with our current medical claims processing team to expedite a new Payer ID with Smart Data Stream (SDS). Once this has been completed, we will communicate additional details.
800-4MY-MAXCARE /(1-800-469-6292) During non-business hours and holidays, our answering service will be happy to take your message and will contact on-call staff to assist you. The person on-call will contact you within 30 minutes. Address: VillageCareMAX. 112 Charles Street.
Participating Providers may submit electronic claims by using VillageCareMAX's Change Health Care Payer ID/Submitter ID: 26545. Electronic Claims must be submitted in 837I or 837P format.
Welcome to the VillageCareMAX Provider Lookup. To get started, tell us what type of plan you have. VillageCareMAX Medicare Total Advantage Plan (HMO D-SNP) VillageCareMAX Medicare Health Advantage Plan (HMO D-SNP)
Each member of VillageCareMAX gets a team of health care professionals working together to get the care member needs. For more information about the plan, please call us at the number above or click on the Member Handbook and Provider Directory links below.
We provide quality care to members in many ways, including: Conducting Quality improvement studies and surveys to ensure we meet your needs. Programs such as Medication Therapy Management (MTM), which is a program that helps members manage their drugs and reduce potential problems.
The benefit package consists of long-term care services covered by Medicaid. We pay for services in the benefit package, replacing Medicaid fee-for-service. We coordinate all health care services for you, even those outside of the Plan’s benefit package.