As a Midlands Choice network provider, you will submit claims for most Midlands Choice patients directly to us for repricing. During repricing, we will apply the fee schedule to each claim, determine which Midlands Choice payers administer your patients' healthcare plans, and forward repriced claims to payers for final adjudication.
Claims are adjudicated by payers after we have repriced and forwarded them. Payers also generate Explanations of Payment (EOPs) for you and Explanations of Benefits (EOBs) for the patient, showing how deductibles, co-pays, coinsurance and benefits were applied to each claim. You will receive payments directly from the payers.
For patients covered by Cigna (including GWH-Cigna) submit claims directly to this delegated payer.
Contact Midlands Choice when you have questions about:
- the fee schedule
- network participation status
Contact payers when you have questions about:
- eligibility and benefits
- claim payments