Retrospective review of medical and Mental Health / Substance Abuse in patient, emergency and out patient services.

Previous payer ID MPM23. Welcome to Piedmont Community Health Plan's provider log-in page. var path = 'hr' + 'ef' + '=';

Health Options of FL(Blue Shield HMO) ENCOUNTERS ONLY!!

var addy_text75a82d6415c492867efec3e159803b05 = 'E-MAIL';document.getElementById('cloak75a82d6415c492867efec3e159803b05').innerHTML += ''+addy_text75a82d6415c492867efec3e159803b05+'<\/a>'; Piedmont Community Health Plan, Inc.2316 Atherholt RoadLynchburg, Virginia 24501, Phone: 434-947-4463toll free: 800-400-7247TTY: 7118:30 a.m. to 5:00 p.m., Monday through fridayclosed holidays, Marketplace Premium Payment 1-888-518-7597. Comprehensive Healthcare Options.com Inc. Delta Dental of California - CA00 Claim Office, Delta Dental of California/Tricare Retiree Dental, Delta Dental of Iowa - Dental Wellness Plan, Delta Dental of Oregon (Oregon Dental Service), Fortis Benefits Ins Co (known as Union Security Insurance Co, Fraternal Order of Police - Dental Div (Philadelphia PA), Group Benefit Administrators (Hendersonville TN), IBT - Local 145 Health Service & Ins Plan, Life Insurance Company of Boston & New York, Local 17 Fund - Intl Association of Heat & Frost Insulators, Masonry Institute/Administrative D. C. No. This is a free service. Payments made after the due date are subject to applicable grace periods and do not guarantee coverage. > ZO \ p Bender, Melissa S B a = ThisWorkbook = %$8 X@ " 1  A r i a l 1  A r i a l 1  A r i a l 1  A r i a l 1 A r i a l 1 $ A r i a l 1 V e r d a n a 1  V e r d a n a 1  V e r d a n a 1 6 V e r d a n a 1  A r i a l 1  A r i a l 1  A r i a l 1  A r i a l 1  A r i a l 1

Multi-Language Interpreter ServicesInterpreters are available to answer any question you may have about our health and drug plans.

- Centra and Sentry Only Marketplace Premium Payment 1-888-518-7597Individual & Group Coverage: (800) 400-PCHP var addy22c6672ac42016fb881b6a273a7c9815 = 'customer.service' + '@';

Senior Health Services Center-Univ American Family Co. Senior Health Services Center-Universal American Family of C, Special Agents Mutual Benefit Assoc (SAMBA), St. Vincent Catholic Medical Centers of New York, Standard Life Insurance Company of New York, Three Rivers Health Plans (Unison Health Plan), Transamerica Financial Life Insurance Company, Transamerica Premier Life Insurance Company, United Concordia Federal Employees Program - DENTAL, United Health Group - Optum Health Behavioral Solutions, United Healthcare Community Plan - Kansas, United Healthcare Facets Detroit Community and State, United Healthcare Facets Pittsburgh Community and State, United Healthcare Securehorizons-Medicare Supplemental, United Teacher Assoc Insurance Co. Mcare Supp, United Teacher Associates Insurance Co-Medicare Supplement, UnitedHealthcare Community Plan (formerly Unison Ohio), University Physicians Care Advantage (Arizona), Virginia Anthem Blue Cross and Blue Shield Dental, Welfare and Pension Administration (WPAS), WellCare Health Plans (WellCare of FL GA NY CT NJ LA OH TX), Wisconsin Anthem Blue Cross and Blue Shield Dental, Wisconsin Medicaid Chronic Disease Program, Blue Medicare of NC -BCBS NC Medicare Adv Plan, Connecticut Bluecare Family Plan (835s returned under CTBLS), Dignity Health - Sacramento Hosp claim shop-Mercy Med Group, Dignity Health Med Found for Mercy Med Gr-Woodland Clin Med, Dignity Health Med Group-Inland Empire (professional risk), Globe Life And Accident Insurance Company, Kaiser Foundation Health Plan of CO (Remits returned KAISR), Kaiser Foundation Health Plan of GA(835 returned under KAISR, Kaiser Foundation Health Plan of the NW (835 ret KAISR), Medicaid of Louisiana Rehab (Remits returned under LAMCD), Sutter Connect Central Valley Medical Group, VA Patient-Centered Community Care Program (VAPCCC) Reg 5A. Medicare Supplement, American Postal Workers Union Health Plan (APWU), American Retirement Life Ins Co. Medicare Supp, American Retirement Life Insurance Co Medicare Supplement. forthe Network Participation Request form (Credentialing for physicians/practitioners). I.





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Your member Identification (ID) Card(s) will be mailed out separately once we receive your initial premium payment.



Preferred Drug List January 2021, 4

iExchange Provider Portal New referral and pre-authorization portal (Effective 8-11-20). This is not a complete list.

Payer returns ERAs automatically once electronic claim submission begins. Piedmont Customer Service(434) 947-4463, (800) 400-PCHP. var path = 'hr' + 'ef' + '='; Depending on the contract with an employer or third party, PCHP may be required to provide some or all of its utilization management services.

This email address is being protected from spambots.

It also covers proactive processes such as; concurrent clinical reviews and peer reviews, as well as appeals introduced by the provider, payer or patient. CLICK HERETo sign up to receive EFT only, or 835/EFT, from Piedmont Community Health Plan Inc. CLICK HERETo sign-up to receive EFT from all payers processing payments on the ECHO platform, afee for this service may be required.

CLICK HERE After that you will be able to: Attention: Piedmont has a new Provider Portal, please click this link to Register as New User.

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Drugs requiring NDC data with claims submission

The information below may be helpful to you when making a payment as a member of Piedmont Community HealthCare.



A. of M. & A.W.

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CLICK HERE



Ameritas Group - Ameritas Life Insurance Co. Ameritas Group - First Ameritas of New York, Ameritas Group - First Reliance Standard Life, Ameritas Group - Standard Insurance of New York, BCBS of Pennsylvania (Highmark) [Institutional], BCBS of Pennsylvania (Highmark) [Professional], Better Health Plans (Unison Health Plans), Blue Cross Blue Shield of Alaska (Premera), Blue Cross Blue Shield of Michigan (Dental), Blue Cross Blue Shield of Michigan (Institutional), Blue Cross Blue Shield of Michigan (Professional), Blue Cross Blue Shield of Oregon (Regence), Blue Cross Blue Shield of Pennsylvania - Highmark, Blue Cross Blue Shield of Pennsylvania (Highmark), Blue Cross Blue Shield of Texas (270/271), Blue Cross Blue Shield of Texas-Medicaid (276/277), Blue Cross Blue Shield of Wisconsin (Anthem), Blue Cross of Washington and Alaska (Premera), BlueChoice HealthPlan of South Carolina Medicaid (HMO), BlueChoice HealthPlan South Carolina Medicaid, Capital District Physicians Health Plan (CDPHP), Carefirst Blue Cross Blue Shield District of Columbia, Carpenters Health and Welfare Trust Fund of St Louis, Carpenters Health and Welfare Trust Fund of St. Louis, Centene - Managed Health Services Indiana, Centene - Managed Health Services Wisconsin, Central Reserve Life Ins Co. Medicare Supp, Central Reserve Life Insurance Company - Medicare Supplement, CHAMPVA/Spina Bifida/Children of Women Vietnam Vets, CHC - Coventry Health and Life (Oklahoma), CHRISTUS Health Plan - NM -Health Insurance Exchange, CHRISTUS Health Plan NM Medicare Advantage, Cigna Voluntary Limited Medical (aka Cigna Voluntary), Colorado Anthem Blue Cross Blue Shield Dental, Community Health Plan of Washington (CHPW), Connecticut Anthem Blue Cross Blue Shield Dental, Constellation Health (INMEDIATA HEALTH GROUP), Continental General Ins Co. Medicare Supp, Continental General Insurance Company - Medicare Supplement, Coresource - Maryland Pennsylvania & Illinois, Coventry Health Care of Carolinas/WellPath, Coventry Health Care Southern Health Services, Coventry Health Care TX (includes Coventry Advantra Freedom), First Reliance Standard Life Insurance Co, First Reliance Standard Life Insurance Company, Food Bakery Confection Workers Fund of So Cal, Georgia Anthem Blue Cross Blue Shield Dental, Government Employees Hospital Association, Great American Life Insurance Co. Medicare Supp, Great American Life Insurance Company - Medicare Supplement, Group Hospitalization and Medical Services, Guardian Life Insurance Co. of America - Dental, Harmony Health Plan (WellCare of Florida), HealthPartners of Minnesota (aka CoOportunity Health), HealthSmart Benefit Solutions - West Virginia, HealthSmart Benefit Solutions (Wells Fargo TPA), Indiana Anthem Blue Cross Blue Shield Dental, Insurers Administrative Corporation (IAC), Johns Hopkins Healthcare (Priority Partners & EHP plans only, Kaiser Foundation Health Plan Inc. - Hawaii Region, Kaiser Foundation Health Plan of Hawaii (DHMO Choice), Kaiser Foundation Health Plan of Northwest, Kaiser Foundation Health Plan of the Mid-Atlantic, Kaiser Foundation Health Plan of the Mid-Atlantic States, Kaiser Foundation Health Plan of the Northwest, Kaiser Foundation Health Plan of Washington, Kentucky Anthem Blue Cross Blue Shield Dental, Loyal American Life Insurance Co. Medicare Supp, Loyal American Life Insurance Company - Medicare Supplement, Maine Anthem Blue Cross and Blue Shield Dental, MEDICARE HIPAA ELIGIBILITY TRANSACTION SYSTEM (HETS), Medicare y Mucho Mas (INMEDIATA HEALTH GRP CORP), Mississippi Children's Health Insurance Program, Mississippi SEHP (State Employee Health Plan), Mississippi State Employees and Teachers Health Plan, Missouri (MO) Health Plan (Community & State), Missouri Anthem Blue Cross and Blue Shield Dental, Montana Medicaid - DPHHS/Health Policy Services Division, Network Health Insurance Corp (Wisconsin), Nevada Anthem Blue Cross Blue Shield Dental, New ERA Life Insurance Company (270 transactions only), New Hampshire Anthem Blue Cross Blue Shield Dental, Ohio Anthem Blue Cross Blue Shield Dental, Oklahoma Employees Group Insurance Division, Op.

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CLICK HERE to access to access 2021 EOPs and Payment information (Note: This is site does not provide current eligibility as of 1/1/2022.). addy75a82d6415c492867efec3e159803b05 = addy75a82d6415c492867efec3e159803b05 + 'pchp' + '.' You need JavaScript enabled to view it. 2021 Pre-authorization Codes

CLICK HERETo sign up to receive EFT only, or 835/EFT, from Piedmont Community Health Plan Inc. CLICK HERETo sign-up to receive EFT from all payers processing payments on the ECHO platform, afee for this service may be required.

Payments are issued by the actual payer. PCHP recognizes that the InterQual serve as guidelines for care under routine circumstances and that in some instances, depending on the status of the member or the availability of medical or Mental Health / Substance Abuse services, these guidelines are not applicable.

90 Degree Benefits - Covenant Administrators, Inc. - Atlanta, Georgia, AAA Northern California, Nevada & Utah Insurance Exchange, AARP United Healthcare Supplemental Plan Only.

Out-patient care utilization management, including management of primary care and specialist practitioner services, out-patient diagnostic and surgical services, emergency services, durable medical equipment and specialty medication prescription management. Here is where Piedmont network providers can access certain online services.Online Registration - new providers need to establish a user name and password before they can login and access information.

Proudly headquartered in Lynchburg, Virginia, Piedmont Community Health Plan provides quality, affordable Health Insurance backed by personal service.

CLICK HERE

After that you will be able to: Attention: Piedmont has a new Provider Portal, please click this link to Register as New User.

Applicable to MN only. 4





For questions regarding enrollment, payment, orPiedmont Individual Marketplace Plans, please call Customer Serviceat434-947-4463or800-400-PCHP, Monday through Friday, from 8:30 a.m. to 5:00 p.m. 8:30 a.m. to 5:00 p.m., Monday through Friday, closed holidays, Our automated payment system is available 24/7 by calling our office at.

Welfare Trust, Diversified Administration Corporation - CT, DMERC Region A Testing is required for claims requiring CMNs, DMERC Region B Testing is required for claims requiring CMNs, DMERC Region C Testing is required for claims requiring CMNs, DMERC Region D Testing is required for claims requiring CMNs.

+ 'net?subject=FROM%20PCHP%20WEBSITE'; Workers Midwest Unions, United Food & Commercial Workers UFCW Local 1529, UNITED HEALTHCARE SERVICES INC(Optum Salt Lake), United Teacher Assoc Ins Co- Medicare Supplement, UnitedHealthcare / UHIS-UnitedHealth Integrated Services, UnitedHealthcare Community Plan - Tennessee, UnitedHealthcare Community Plan / KS (KanCare), UnitedHealthcare Community Plan of Pennsylvania, UnitedHealthcare Community Plan of Washington, UnitedHealthcare Facets Detroit - Community and State, UnitedHealthcare Military & Veterans / TRICARE West, UnitedHealthcare West (formerly PacifiCare of Colorado), UnitedHealthcare West/UnitedHealthcare of CAOKORTXWA, UnitedHealthcare/UnitedHealthcare W Encounters form PacifiCa, Unitrin Direct Property & Casualty Company, Univera - Health Care Plan/ChoiceCare Buffalo, University Family Care - Healthcare Group, University Family Care - Maricopa Health Plan, University of IL at Chicago Div of Specialized Care for Chil, USAA (United Services Automobile Association), USFHP - St. Vincent Catholic Medical Centers of New York, Utica NY FEP (Federal Employee Program) Blue Shield, VA Patient-Centered Community Care Prog (VAPCCC) Region 5A, Value Options/MBHP (MA Behavioral Health Partnership), Verity Medical Foundation (DCHS Medical Foundation), Vestica Healthcare - Value-Based Solutions, VieCare Life Beaver and Life Lawrence Counties, Virginia Anthem Blue Cross and Blue Shield, Vista Oncology - New Century Infusion Solutions, WA State Premera Blue Cross (835s returned under AC032), Washington County Health and Human Services, Washington State Council of County & City Employees (WSCCCE), WASHINGTON State Dept of LABOR & INDUSTRY, Waterstone Benefit Administrators (Oklahoma Providers), Waterstone Benefit Administrators (Outside Oklahoma), webTPA/Community Health Electronic Claims/CHEC, Wellmark Blue Cross and Blue Shield of Iowa (IASD), Western National Insurance (Pioneer Specialties), Western Southern Financial Group (Cincinnati OH), Willamette Valley Comm Health CCO (Marion Polk Health Plan), Wilson Mutual Insurance (All States Except WI/MN), Wisconsin Anthem Blue Cross and Blue Shield, Wisconsin Chronic Disease Program (WICDP), Wisconsin Physicians Service - Third Party Pricing, Women's Integrated Network Inc. (WIN Fertility), Woodman Accident and Life Co (AICT Plans only), Wyoming School Boards Association Insurance Trust, XL Insurance America Inc. (Aaris Captive), Xl Specialty Insurance Company (Deductible), Z-Nat Insurance (Zenith National Insurance), AHS State Network (Mississippi Blue Cross), Blue Care Network/Blue Cross Blue Shield of Michigan, Blue Cross Blue Shield of Missouri (Blue Cross), Blue Cross Blue Shield of Tennessee Network H, Blue Cross of Nebraska (835s returned under NEBLS), Blue Shield of OK Remits will be returned with payerID OKBLS, CO NM OK TX - MEDICARE PART A (MAC J4) LEGACY WPS, Correctcare Integrated Health (CA Prison Health Care Service, EBMS (Employee Benefit Management Services Inc.), Excellus - Blue Cross Blue Shield Central NY, Excellus - Blue Cross Blue Shield Rochester Area, GHI - Medicare PPFS (Private Fee for Service), Hawaii Medical Assurance Association (HMAA), Health Adv/US Able/First Pyramid Life/Arkansas Blue Cross, Health Net - California (Institutional Encounters ONLY), HOME HEALTH & HOSPICE - JURISDICTION A (MAC JK - NGS), HOME HEALTH & HOSPICE (MAC J15 - JURISDICTION B) CGS, Life Investors Insurance of America - Long Term Care, MEDICARE PART A LEGACY WPS (DC DE MD NJ PA) (MAC JL), Memorial Hermann Health Network Providers, Mountain State Blue Cross of West Virginia, National Imaging Assoc Inc / Magellan Health Services, New Mexico Blue Cross Community Centennial, Pennsylvania Highmark Blue Shield - Central, Rocky Mountain Health Plan- Grand Junction, Seton Employee Plan Care Program I Par Plus, Travis County Hospital District MAP I Par Plus, True Choice USA - Christus Healthplan I Par Plus, TX Medicare Part A and Indian Health Services J4, Univera Healthcare SSA WNY PPO Traditional, Ameritas Life Insurance Corp. of New York, Blue Cross Blue Sheild DE Fully-Insured Dental Group Bus, Blue Cross Blue Shield Association - FEP Dental, Blue Cross of North Dakota (ND Dental Services), Civil Service Employees Association (CSEA). CLICK HERE for first-time registration and for online account access. var addyf3ee5cd3960220dc2fcc5b9299972b1f = 'pchp.eligibility' + '@'; Local No. - All Others.

), Phillips-Van heusen Corporation (PYH Corp), Phy Choice Med Grp San Luis ObispoSan Luis Obispo Select IPA, Physician Associates of Greater San Gabriel Valley, Physician Health Coop/SRRIPA Stones River Reg IPA Humana 837, Physicians Care Network (ASR Corporation), Physicians Care Network (Rockford IL only), Physicians Choice Medical Group of Santa Maria, Physicians Corporation of America (Florida Plan Only), Physicians Health Association of Illinois, Physicians Health Plan of Northern Indiana (837P and 837I), Physicians Health Plan PHP South Michigan, Physicians Medical Group of Santa Cruz County, PIH Health (Formerly Bright Health Plan), Preferred Community Choice/PCCSelect/CompMed, Preferred Employers Insurance Company (PEI), Preferred Health Professionals Kansas City, Presence Health Partners/FKA Resurrection Health Care Prefer, Primary Care Assoc of CA (Customer Service877-602-1563), Professional Benefit Administrators Inc. (Oak Brook IL), Progressive Northwestern Insurance Company, Providence Insurance & Administrative Services, Providence Preferred (PPO) (ProviderID & Enrollment required, Rancho Santiago Community College District (CA), Redwood Empire Municipal Insurance Fund (REMIF), Redwood Empire Schools Insurance Group (RESIG), Redwood Fire and Casualty Insurance Company (Member of BHHC), REGENCE BLUE CROSS BLUE SHIELD OF UTAH (Includes FEP), ReliaStar (now known as CoreStar formerly NW National Life), Resolve Health Plan Ad (Auth # required: begins w5 &13len. Payer returns ERAs automatically once electronic claim submission begins.

428 Health & Welfare Trust Fund, PacificSource Community Solutions (Medicaid), Panamerican Life Insurance Company of Puerto Rico, Penn Treaty Network America Ins Medicare Supp, Preferred Medicare Choice(PMC)(INMEDIATA HEALTH GRP), Principal Financial Group (Principal Life) - Dental & Vision, Prominence Preferred Health Insurance Company, Provident American Life & Health Ins.

var addy75a82d6415c492867efec3e159803b05 = 'customer.service' + '@'; TTY ServicesTTY users should call 7-1-1 for assistance. Health Medicaid, Health Select IPA (Enrollment required Contact 866-703-1444), Health Services for Children with Special Needs, Healthgram Inc (formerly known as Primary Physician Care), HealthNow - Blue Cross Blue Shield of Western NY, Healthsmart Management Services Organization Inc, Healthsource AR-Claims cont Healthsource spec VendID&Rend Pr, HealthSpan Integrated Care accept claims DOS to 1-31-2017, HealthSpring HMO/HealthSpring Medicare+Choice, Hemet Community Med Group ( 951-791-1111 prior to submitting, Highmark Blue Cross & Blue Shield of Pennsylvania, Highmark Senior Health Company (PA Blue Shield Medicare Plan), HIP - Health Insurance Plan of Greater New York, HMSO-Highline Medical Service Organization, HP Administrative Services LLC DOS prior to 01/01/2018), HPMS Send claims to payerID listed on patient's ins card), Humana Insurance Company Choice Care Network, Humboldt-Del Norte Foundation for Medical Care, Hylton Payroll (Benefit Plan Administrators), IA Teamsters Health Ben Fund Local 135 Health Benefits Fund, Illinois Health Solutions ( ProviderID Required), Independence Medical Group of Kern County, Indiana Department of Health - Children's Health - Claims, Indiana University Health Plan (Commercial IUHPLNS), Indiana University Health Plan (Medicare), Ingalls Provider Group (New PID for DOS 1-1-19 & after only), Innovative Claim Solutions (ICS) - Rancho Cordova, Innovative Claim Solutions (ICS) - San Ramon, Insurance Management Services (Amarillo TX), Integra Administrative Group (Seaford DE), Integrated Care Network (ICN) by Emerald Health, Integrity Administrators (Champion Chevrolet), Integrity Mutual Insurance Company (WC Only). The Piedmont Community Health Plan complaint and appeal system is to ensure that a fair an orderly process is available to covered members and to providers representing covered members in order to resolve disputes that are related to or arise out of contractual coverage with Piedmont Community Health Plan and Piedmont Community HealthCare.

This can be found on your invoice or if you are new to the plan, your welcome letter. The PCHP Utilization Management Program applies to all members for whom PCHP contracts to provide medical management services, including all members of Piedmont Community Health Plan and HealthCare. Out-patient Mental Health / Substance Abuse utilization management, including management of services by Mental Health / Substance Abuse practitioners and Mental Health / Substance Abuse diagnostic testing.

You need JavaScript enabled to view it. You will need your member number from your ID card or invoice. Piedmont does not charge any fees with any of our methods of payment. For more detailed information, please go to the link provided for the Piedmont Community Health Plan Utilization Management Policies and Procedures.

You can make your initial premium payment using one of the following methods: Piedmont Community Healthcare, HMO Inc. PO Box 411127Boston, MA 02241-1127. 21st Century Insurance and Financial Services, AAG-American Admin Group ( Formerly Icon Benefit Admin), Acceptius (Benefit Management Inc of MO (BMI), Accountable HC IPA claims w/DOS prior to 5/1/15, Adventist Health System West - Roseville CA, Advocate Medical Group - AMG (Legacy AHC), Aetna Affordable Health Choices (SM) - SRC, Aetna Senior Supplemental Insurance (Aetna SSI), Affiliated Doctors of Orange County (ADOC), AFL-CIO Food & Beverage Dealer's Trust Fund (Toledo OH), Alamitos IPA (Customer Service 562-602-1563), Alexian Brothers Community Services of TN, Allianz Global Corporate & Specialty (AGCS), Allmerica Financial Benefits Insurance Company, American Administrative Group - AAG Form known as UICI Admin, American Administrative Group AAG (Gallagher Benefits), American Family (administered by American Republic), American Postal Workers Union Health Plan, American Therapy Administrators ATA Wisconsin, Americas 1st Choice Health Plans of South Carolina, Americas 1st Choice of South Carolina Inc, Amerigroup - Maryland and District of Columbia, Amerigroup Multiple States (Claims and Encounters), AmeriHealth Caritas Next a product of AmeriHealth Caritas North Carolina, AmeriHealth Caritas VIP Care Plus (Michigan), Amerihealth HMO of Delaware and New Jersey, Anthem Blue Cross and Blue Shield - Indiana, Anthem Blue Cross and Blue Shield - Kentucky, Anthem Blue Cross and Blue Shield (Virginia), Anthem Blue Cross and Blue Shield of Ohio, Anthem Blue Cross Blue Shield of Connecticut, Arizona Physicians IPA - Community and State, Arkansas Managed Care Organization (AMCO), Association County Commissioners of Georgia (ACCG), Athens - Community Hospital Of Monterey Peninsula, Atlantic PPO to American Commerce Insurance, Atlantic PPO to Bristol West Insurance Group, Atlantic PPO to Citizens United Reciprocal Exch. 9.





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'+addy_textf3ee5cd3960220dc2fcc5b9299972b1f+'<\/a>'; Enrollment434-947-4463800-400-7247This email address is being protected from spambots. var path = 'hr' + 'ef' + '=';





As a valued Piedmont Provider, our goal is to assist you in serving our members.

ACS Consulting Services (Hawaii) Medicaid, Actuarial - Employee Benefit Services Benovation (Enhanced).

Payer returns ERAs automatically once electronic claim submission begins.

2020 Pre-authorization Codes CMS Glossary of Health Coverage and Medical Terms. (E.B.P.A. for the step-by-step user guide for the new provider portal setup.



Your policy and benefits will nottake effect on your effective date of coverage until Piedmont receives your initial premium payment.