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Frequently Asked Questions

1. What benefits are there to working with NorthCoast?

If you are a discharge planner……..

One call to NorthCoast makes your job much easier. We verify the patient’s insurance benefits saving you time. If the patient does not have a preference of provider, NorthCoast will contact one of its network providers located close to the patient’s home and arrange for the services to be provided. You will get a call back informing you who will be the provider. It is that easy!

If you are a home care provider………….

With NorthCoast you may serve Anthem, other Blue Cross/Blue Shield, and Medical Mutual patients. With very limited exceptions, Anthem has embraced the network model requiring providers to go through the network for authorizations and billing.

We save you time! We will verify the insurance benefits prior to the start of care and monthly thereafter. Our claims department converts your claims to the format requested by the payor. If the insurance company requests additional information or an appeal is needed, we will do that.

NorthCoast is committed to treating our patients and providers with integrity and fairness. We will work with you to achieve the highest outcome possible for the patient.

If you are a payor…………

Working with NorthCoast gives you access to over 250 home health, hospice, and home infusion providers. One contract and one very seasoned organization to work with for claims processing.

2. I already have a contract with Medical Mutual (MMO). Should I sign up for Medical Mutual through the network?

Many of our providers have their own direct contract with MMO. If you get the referral, you do not need to bring it to the network unless you want to do so. You can service the patient and bill directly. However, if we call you with the referral, you will need to work with us for authorizations and billing purposes. As a member of our MMO panel, you will have an opportunity to service patients that you might not otherwise see. Some of our providers feel that it is easier, more efficient, and less time consuming overall to work with the network rather than dealing with the payor directly.

3. What do we do if we have a patient who is discharged on the weekend?

We have on-call nurses available 24/7 to coordinate weekend or holiday referrals or re-referrals. They can be contacted by calling our toll free number, 800-757-7111.

4. How long does it take to become a provider for the network?

That really depends on how quickly you complete and return the credentialing package and contracts. Credentialing is a standardized process in compliance with the Ohio laws. The contract is reviewed and discussed concurrently. Both can be processed within a few days. Shortly after becoming a network provider, NorthCoast will provide an operations orientation to your organization for the network processes. Providers find that this orientation is very helpful to clarify expectations and needs.

5. What areas do you serve?

NorthCoast serves Anthem Blue Cross/Blue Shield patients receiving care in these Service Areas:

NORTHERNOhio counties: Ashtabula, Belmont, Carroll, Columbiana, Cuyahoga, Defiance, Erie, Fulton, Geauga, Harrison, Henry, Holmes, Huron, Jefferson, Lake, Lorain, Lucas, Mahoning, Medina, Ottawa, Portage, Sandusky, Seneca, Stark, Summit, Trumbull; Tuscarawas, Wayne, Williams, Wood; Michigan Counties: Hillsdale; Lenawee; Monroe Pennsylvania Counties: Beaver; Crawford; Erie, Lawrence; Mercer. West Virginia Counties: Brooke, Hancock, Marshall, Ohio.

CENTRAL: Ohio counties: Ashland, Athens, Coshocton, Crawford, Delaware, Fairfield, Fayette, Franklin, Gallia, Guernsey, Hardin, Hocking, Jackson, Knox, Lawrence, Licking, Madison, Marion, Meigs, Monroe, Morgan, Morrow, Muskingum, Noble, Perry, Pickaway, Pike, Richland, Ross, Scioto, Union, Vinton, Washington, Wyandot; West Virginia counties: Pleasants, Tyler, Wetzel, Wood.

SOUTHERN: Ohio counties: Adams, Allen, Auglaize, Brown, Butler, Champaign, Clark, Clermont, Clinton, Darke, Green, Hamilton, Hancock, Highland, Logan, Mercer, Miami, Montgomery, Paulding, Preble, Putnam, Shelby, Van Wert, Warren; Kentucky counties: Boone, Campbell, Gallatin, Grant, Kenton, Pendleton.

Please note:  Medical Mutual of Ohio patients are not limited by service areas.

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