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Billing and Claim Submission

Welcome to the Community Care, Inc. billing and claim submission page. This page is for contracted Community Care providers who would like to be reimbursed for services rendered. Providers billing Community Care are required to bill using either a UB-04 claim or a standard CMS-1500 form. Community Care has provided icons below to assist in identifying the appropriate manner in which to submit your billing. Please click on the icon which best identifies your current billing situation or best describes the type of services you provide.

Never Billed Us Before? 

Residential ServicesSupportive Home CareButton_MedicalServices          General Services
 

For any questions or concerns please contact the provider hotline toll free at 1-866-937-2783 option "1" between the hours of 8am to 4:30pm Monday through Friday (Central Time).

Balance Billing of Community Care Members

Per CMS and your contract with Community Care, you can not balance-bill our members.

CMS published, as did the Social Security Act (referenced within these publications) regarding QMBs (Qualified Medicare Beneficiary's).

In Summary:

  • All our dual eligible members in PACE, Partnership and Family Care are QMBs
  • Federal law prohibits providers from billing QMBs for Medicare deductibles, coinsurance, or copays for any Part A or Part B service (see Sections 1902(n)(3)(B), 1902(n)(3)(C), 1905(p)(3), and 1848(g)(3)(A) of the Social Security Act [the Act])
  • In states that have adopted a lessor of pay policy such as Wisconsin the state may limit their payment to the difference between the Medicaid rate and the amount Medicare has already paid which may result in no Medicaid payment if the Medicare paid    amount is greater than the Medicaid allowed amount
  • QMBs cannot elect to pay any Medicare deductibles, coinsurance, or copays

Change in Claim Payment Schedule beginning the Week of August 5, 2019
As a non- profit Managed Care Organization (MCO), Community Care, Inc. continuously strives to reduce administrative costs and maximize efficiency.  As part of those efforts, Community Care Inc. will be reducing the number of check runs to issue claim payments from twice a week to once a week. Generally, the weekly claim payments will be issued on Wednesdays but is subject to change during holiday weeks. This calendar will be updated if the schedule changes. Click here to see the proposed calendar for 2019.


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 Corporate Headquarters: 205 Bishops Way, Brookfield, WI 53005
Phone: (414) 231-4000 Toll Free: 1-866-992-6600 TTY: Call the Wisconsin Relay System at 711
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