Coventry Health Care values the quality care that health care providers give to our Advantra members, and it is our goal to provide prompt reimbursement for those services.

A key factor in getting Advantra claims processed in a timely manner is correct claims submission: utilizing proper mailing addresses for paper claims and appropriate payor ID’s for EDI claims.  Submitting a claim correctly the first time increases the cash flow to your practice, prevents costly follow-up time by your office or billing staff, and reduces the uncertainty members feel with an unresolved claim.  To support that effort, Coventry has multiple options available for its providers to choose from, including our secure provider portal, directprovider.com.

directprovider.com is your portal to better health care delivery.

It allows providers the ability to verify Eligibility benefit information before services are rendered.  The Claim Inquiry section provides the ability to view claims by status (Paid, Pended, Denied, Rejected, etc.), and search for claims by member, claim number, or date range, for any 30-day period, with up to 3 years worth of Claims History available.  Claims disposition codes are easy to understand and each claim clearly displays member responsibility.  You can see pre-existing conditions, authorization numbers, and line level detail for each claim, as well as the date we received the claim and how and when it was transmitted through our system.  The Online Claims Adjustment Reconsideration function even allows a provider the opportunity to request a review/reconsideration of a claim that they feel did not properly adjudicate, even at the claim line level, and submit documentation online in support of that request.

Coventry prides itself on the EDI tools it has available for its Medicare/Advantra providers and, with directprovider.com, Coventry can boast one of the most multi-functional payer websites available to its providers in the healthcare industry.  For more information on directprovider.com, please visit the ‘Secure Provider Portal’ section of this website.
 
For specific information concerning EDI claims and other claim matters, including Advantra HMO/PPO and Advantra Freedom differentiation documentation, please also refer to the EDI Documentation link for further support documentation.