Network Support Services

The Network Services Department is available to assist practitioners and facilities that provide service to our members. This section provides helpful information, newsletters, and forms.

Network News is published by Capital Health Plan Network Services. It has timely information relevant to your practice and your relationship with CHP. Network News can be accessed through CHPConnect.

Electronic Claims Submission

CHP currently accepts electronic claims submission from three Clearinghouses: EmDeon, Gateway, and Availity. Our Payer ID number is 95112. You will need to follow the submission guidelines in our EDI Companion Guide. Prior to submission of your initial file you must notify CHP of your intention to transition to electronic submission. You can fax the Electronic Claim Submission Enrollment form to Network Services at (850) 523-7351 or call us at (850) 523-7361. The notification will provide us with enough information to verify receipt of your initial file.

We also offer direct data entry of claims through CHPConnect. Through CHPConnect you are able to enter your claims data on an individual basis and eliminate paper submission. You will need to have access in order to use this functionality. Please go to the CHPConnect page to register.

Direct Deposit

PaySpan is health care's leading provider of payment reimbursement solutions. The PaySpan network connects over 700 health plans with over 1.3 million provider payees and 107 million consumers. With the largest health care network in the U.S., PaySpan provides payment automation services that improve administrative efficiency, meet regulatory requirements, and allow providers to manage their reimbursements.

CHP has partnered with PaySpan to provide claim reimbursement and remittance advice for our providers. This free service electronically deposits CHP provider reimbursement payments to the bank account(s) of your choice via electronic funds transfer (EFT) and provides online access to Explanation of Benefits (EOBs) and payment reconciliation reports.

Follow the instructions below to set your practice up for PaySpan's direct deposit:

Register for your unique PaySpan registration code(s) online.
Register for your unique PaySpan registration code(s) via email with Provider Support.
- Please use subject line "Registration Code Request - Capital Health" and include the Tax Identification Number for your practice in the body of the email. Your payments will be received via mail until you enroll in EFT.
Once you receive your unique PaySpan registration code(s), you can then enroll in EFT.

For additional assistance, please visit PaySpan Support, email PaySpan Support directly, or call 877-331-7154 option 1.

Credentialing of Network Providers

Capital Health Plan is committed to providing our members in Leon and the surrounding counties with high-quality affordable health care. CHP verifies each practitioner's or provider’s credentials to assess their ability to deliver care to our members based on criteria that include licensure, relevant training, conduct, and experience.

Initial credentialing is completed upon acceptance to be a part of the CHP network and re-credentialing is completed every three years thereafter.

Practitioners have specific rights related to the credentialing process:

You have the right to be informed of the status of your credentialing application.
You have the right to review information obtained through the verification process, although this does not apply to references, recommendations, or other information that is peer-review protected.
You have the right to clarify or correct information on your application that is inconsistent with information obtained via primary source verification. CHP’s Network Services staff will contact you in writing if they identify an inconsistency in the information received through primary source verification. To clarify or correct information in your credentialing file, submit the correction in writing to CHP’s Network Services Manager within 10 business days from the date you viewed the information. CHP will review your submission and respond in writing within 30 days of receipt.

If you should have questions regarding the credentialing process or the status of your application, you can contact Network Services at (850) 523-7361 or by emailing Network Services directly. CHP will provide you with status within 10 business days.

Compliance

Compliance Program

Capital Health Plan's Compliance Program is composed of eight essential elements. The following represents a brief description of each element.

Written policies and procedures. Capital Health Plan’s Code of Conduct is issued to all employees upon hire and upon request to the public. Additional clarifications regarding compliance guidance are issued in various publications of CHP.
Designation of Compliance Officer and Compliance Committee. CHP has had a Compliance Officer, who also is the Chair of the Compliance Committee, for over 18 years. The Compliance Committee meets regularly throughout the year and additional information regarding these meetings or the Compliance Officer responsibilities are available upon request.
Effective training and education. Compliance training is a combination of classroom, one-on-one, and computer-based training. All new employees are trained the first week of employment and then annually. Successful training requires a minimum score set by the Compliance Committee that all employees must attain. Additionally, Compliance training is also required for temporary staff, students, consultants, and vendors.
Effective lines of communication. The Compliance Officer utilizes email, mail, face-to-face, and a hotline for open communication about compliance concerns. To report anonymously, call the hotline at 850-383-3566.
Enforcement of Compliance standards. Compliance standards enforcement is the responsibility of all CHP management, and our Code of Conduct adherence is expected of all employees. Failure to comply would result in disciplinary action up to and including termination.
Conducting Internal Monitoring & Auditing. CHP’s Compliance Department interacts with all departments and oversees all facets of the organization to ensure adherence to the moral, ethical, legal, and regulatory standards that govern our industry. Various reporting tools and collaborative efforts are employed in the oversight process. Research, analysis, auditing, and monitoring of internal/external stakeholders occurs to ensure organizational compliance with all relevant laws and regulatory requirements on both state and federal levels. Reports and findings are shared with the Compliance Committee, Audit Committee of the Board, and any other relevant workgroups or parties.
Procedures for prompt responses to offenses. The Compliance Program requires timely investigation of any reported violations and appropriate disciplinary action as noted in our policies.
Fraud, Waste & Abuse. The Compliance Program detects, corrects, and works to prevent any issues related to fraud, waste, and/or abuse. The Fraud, Waste & Abuse (FWA) policy is part of new employee training and annual training for all employees. In addition, FWA training is also provided by SIU quarterly.

This summary is not intended to be all-inclusive of the entire scope of Capital Health Plan’s Compliance Program, but is designed to present a high-level overview of the compliance elements currently in place.

Please call the Capital Health Plan Compliance Department at 850-523-7299 should you have any questions regarding this material.

Behavioral Healthcare Services

The Federal Mental Health Parity and Addiction Equity Act describes federal and state requirements for Behavioral Healthcare Services and includes contact information for the Department of Financial Services for inquiries or complaints.

You may also visit the Florida Division of Consumer Services at: https://www.myfloridacfo.com/Division/Consumers/ConsumerProtections/BehavioralHealthOverview.htm

To submit inquires or complains, you may use the contact information listed below.
FLORIDA INSURANCE CONSUMER HELPLINE
Statewide/Toll-free: 1-877-693-5236 Out of State: (850) 413-3089
FAX: (850) 413-1550
EMAIL: Consumer.Services@myfloridacfo.com
ONLINE: Online Insurance Assistance

No Surprises Act Notice

The No Surprises Act (NSA) establishes new federal protections against surprise medical bills that take effect in 2022. Surprise medical bills arise when insured consumers inadvertently receive care from out-of-network hospitals, doctors, or other providers they did not choose.

Click here for Capital Health Plan’s No Surprises Act Notice.

Section 1557 Nondiscrimination Notice

Section 1557 makes it unlawful for any health care provider that received funding from the Federal government to refuse to treat an individual – or to otherwise discriminate against the individual – based on race, color, national origin, sex, age or disability.

You may access our Nondiscrimination and Accessibility Notice at anytime.

Notice of Privacy Practices

This Notice of Privacy Practices is for members who receive services from Capital Health Plan facilities and providers located at Centerville Place or Governor’s Square Boulevard. The practices described in this notice also apply to all health information received by Capital Health Plan at any of our business locations from independent health care providers, insurers, or other entities that may send us information.

You may access our Notice of Privacy Practices at anytime.

Privacy Practices

Capital Health Plan knows that the way we conduct our business offers us the opportunity to earn our members' respect and trust. Our members are our reason for being. To that end, we believe our members have the right to privacy and that their non-public personal, financial, and health information should be kept confidential.

Privacy Of Personal Health Information

All CHP member health information is confidential. Disclosures for purposes other than treatment, payment, or health care operations are made only when CHP receives a member's Authorization to Use or Disclose Protected Health Information.

CHP does not accept requests to disclose personal information to employers or plan sponsors (organizations that pay for an employee's health benefits) with the exception of summary health information, enrollment, and disenrollment information.

CHP safeguards oral, written, and electronic information. Confidentiality agreements are signed with any contracted parties that receive a member's confidential personal, financial, or health information. Access to this information is restricted to those employees who use the information to provide services for members.

CHP's privacy program conforms to all state and federal laws, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

CHP sends every new member a Notice of Privacy Practices. The Notice includes explanations, instructions, and examples of:

the content of a member's medical record

member rights regarding health information

CHP's responsibilities to maintain privacy of your health information

routine uses of health information for treatment, payment, and health operations and

how to contact CHP with questions or concerns

Members have a right to:

view, inspect, copy, and amend their health records

request limits on certain uses of their health information

get an accounting of health information disclosures

request communications of their health information by alternative means or at alternative locations and

revoke their authorization to use health information, except when action already has been taken

Members can enter information on CHP's secure website, CHPConnect. This information is accessed and used by the Member Services Department to assist members. Information can be entered to:

select a new, or change a primary care physician

obtain a replacement CHP ID card

Capital Health Plan members may also securely email Member Services at memberservices@chp.org for benefit plan-related questions. You may need to copy and paste the email address into your email program. Please include a call-back number if you would like us to respond to your email. We will not respond by email.

Note: All medical advice questions should be directed to your Primary Care Physician or to the CHP Health Information Line to ensure a timely and accurate response.

Additional information is posted below. This Privacy Notice is provided to help you better understand how we protect your non-public personal, financial, and health information. If you have questions about our privacy policy, please feel free to contact us. If you are one of our members you can call Member Services at 850-523-7441 or 1-877-247-6512 (TTY 850-383-3534 or 1-877-870-8943) 8:00 a.m. – 8:00 p.m., seven days a week, October 1 – February 14; 8:00 a.m. – 8:00 p.m., Monday – Friday, February 15 – September 30. State of Florida members call 1-877-392-1532, 7:00 a.m. – 8:00 p.m.

Privacy Notice to Our Members

This Privacy Notice is provided to help you better understand how Capital Health Plan protects your nonpublic personal, financial, and health information.

You may access our Privacy Notice at anytime.

Fraud, Waste, and Abuse Notice Training

CHP has maintained a program to protect and prevent fraud, waste, and abuse (FWA).

FWA Reporting Policy

Medicare Fraud & Abuse: Prevention, Detection, and Reporting

FWA Training

HEAT - Provider Fraud Prevention

Red Flag Rule - Identity Theft Prevention Policy

Federal law defines medical identity theft as: a fraud committed or attempted using the identifying information of another person without authority to obtain medical services or goods, or when someone uses the person’s identity to obtain money by falsifying claims for medical services and falsifying medical records to support those claims.

You may access our Identity Theft Prevention Policy at anytime.