Important Notice to Providers Regarding
Universal Health Care Insurance Company, Inc. (UHCIC),
The claim filing deadline has passed
The claim filing deadline was 11:59 P.M. June 30, 2014
Please take time to read the Frequently Asked Questions that may help you with the filing of your claim.
The Proof-of-Claim (POC) filing requires a two (2) step process:
Proof-of-Claim forms must be submitted to the Receiver (See Step 1)
Medical Claims must be submitted to PayerFusion Holdings, LLC (See Step 2)
Step 1: Submission of Completed Proof-of-Claim
If you do not have a Proof-of-Claim form, you may request one using the Contact Us link. To ensure receipt of your Proof of Claim form, please return the form using Certified mail, return receipt requested.
Note: POC forms must have been submitted to the Receiver before the claim filing deadline of June 30, 2014 in order to be considered timely filed. All POCs received after the claim filing deadline may be considered “late filed” in accordance with Florida Statutes.
POCs should be mailed to:
Florida Department of Financial Services, Receiver
2020 Capital Circle SE, Suite 310
Tallahassee, FL 32301
Only one POC should be completed per each unique National Provider Identifier (NPI). (A claim is the aggregate amount due to a provider or billing entity for outstanding charges for services provided on or before the date of liquidation).
Claims can only be submitted by the entity who owns the NPI on file with the Centers for Medicare and Medicaid Services (CMS). If any distribution is made in this estate to medical providers, the checks will be issued only to NPI owners. The receiver claim number (“RCN”) was assigned to the NPI owner.
Medical claim forms that are forwarded to PayerFusion should also show the NPI number for the provider that rendered service to the member. For questions regarding submission of the POC, please review the instructions included or contact the Receiver at this link: Contact Us.
Step 2: Submission of Medical Claim Forms:
Medical claims will be evaluated by a third-party-administrator (TPA): PayerFusion Holdings, LLC.
In addition to the POC submitted separately to the Receiver (see Step 1), medical claims must be submitted to PayerFusion Holdings, LLC for adjudication. The total amount claimed on the POC should equal the total of the medical claims submitted. Please discontinue routine billing on all UHCIC accounts.
Appeals: Any appeals adjudicated prior to the liquidation must be included with your claim.
Medical Claims Evaluation Equitable Methodology: In an effort to apply an equitable and cost efficient methodology to every claim and to treat all medical provider claims equally, the rates used represent standard Medicare rates. Regardless of any other prior existing contracts or fee schedules all eligible medical claims were evaluated at 100% of 2013 applicable regional Medicare rates and Medicare coverage and billing guidelines. Unbundled line items in a claim that do not meet Medicare Correct Coding Initiative Guidelines will be repriced to zero.
Note: Medical claims submitted to PayerFusion Holdings, LLC after the deadline may be considered late filed.
Electronic Submission (Preferred): The HIPAA compliant data may be submitted through the third-party-administrator’s contracted clearing-house vendor Emdeon via Payer ID number 27048.
Please note, you do not have to use Emdeon as your vendor in order to submit the claims electronically via your practice management system. The claims may be submitted using Payer ID number 27048 via the electronic claims option of your billing system. The clearinghouse tied to your Practice Management System software vendor should be able to accept the claims for Payer ID number 27048 and forward to Emdeon. You can locate PayerFusion Holdings’ Payer ID number 27048 by searching “PayerFusion” in your clearinghouse’s Payer Listings or by entering the Payer ID number directly. Emedeon has sent routine update notices to all potential clearinghouses. If you have further questions on how to submit your claims electronically, please contact PayerFusion Holdings, LLC, at firstname.lastname@example.org or call toll-free 855-414-8242 or by asking your Practice Management System software vendor for assistance.
Paper Submission: Paper billing should be forwarded to the TPA directly only if you are unable to submit them electronically. It is recommended they be sent Return Receipt Requested. Please send paper claims to:
PayerFusion Holdings, LLC
PO Box 260866
For questions regarding submission of electronic or paper medical claim billing information please contact PayerFusion Holdings, LLC, at email@example.com or call toll-free 855-414-8242.
Special information for providers with policyholders in Arizona, Mississippi, North Carolina, Ohio and Pennsylvania:
These states’ Guaranty Associations have been triggered by the insolvency of UHCIC. They will be relying on information provided by the Receiver’s POC process for evaluating claims and those states’ Guaranty Associations potential covered obligations. The five affected Guaranty Associations will evaluate and pay claims as submitted subject to GA coverage limits; those states’ Guaranty Associations will then have a claim against the estate in place of the claimant in the amount of the affected GA’s payments to providers.
Please remember that pursuant to state and federal law and/or the terms of your contract, providers are prohibited from balance billing managed care enrollees.
The Claim Filing Deadline has passed.
The claim filing deadline was 11:59 P.M. June 30, 2014
I received a payment from Universal for services provided to one of their members; however, the amount of payment is more than owed. What should I do?
The Receiver will contact you regarding the overpayment.
Additional information concerning the receivership process is available at http://www.myfloridacfo.com/Division/Receiver