Provider/Network

Welcome Providers

Caprock HealthPlans understands that we are in partnership with you, the provider, to offer the best possible health care choices for our members. Our responsibilities to our provider partners include making the claim submission process as easy and efficient as possible and providing timely, accurate reimbursement for services.

Caprock HealthPlans maintains a comprehensive site where providers can make standard inquires online and access accurate, up-to-date information on eligibility, benefits information, and claims and payment status.

Quick Menu:

Claims Submission

Use the information in this section to expedite your claims payments by submitting all required information.

Electronic Claims Submissions

Electronic claims submission is available through Smart Data Solutions using Payer ID Number CAPHP.

Submission Tips:
» Use the correct Payer ID Number
» Use the billing name and address on the electronic billing format that matches our records. Please notify our office of any name and address change in writing.

Paper Claims Submissions

Paper claims should be mailed to:
Caprock HealthPlans
PO Box 21548
Eagan, MN 55121-0548

Claim Appeals

Submit your appeal to the address below for claim denials regarding untimely filing, incidental procedures, bundling, unbundling, unlisted procedure codes, non-covered codes, etc. Claims must be submitted to Caprock HealthPlans within 90 days of the date of denial from EOB.

Caprock HealthPlans
Attn: Appeals
PO Box 54139
Lubbock, Texas 79453
or
Faxed to: 806-698-5823

Corrected Claims

Corrected Claims can be mailed or faxed. Make sure you clearly mark the top of your claim with the wording "Corrected Claim" to avoid claim from being processed as a duplicate.

Caprock HealthPlans
Attn: Appeals
PO Box 54139
Lubbock, Texas 79453
or
Faxed to: 806-698-5823

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Network Participation

A growing network for your growing practice!

Join The CapStar Network Click Here

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Online Services

Why register to use our Provider Portal?
Anytime, anywhere access to up-to-date information that is important to you.

Interactive tools make it easy to:
  • » View claim status
  • » Verify member eligibility
  • » Display benefit plan details
  • » Contact Customer Service


Make the most of your time and quickly find the information you need. Log in today!

Provider login

Providers will have online access to the following employee and dependent information.

  • » Eligibility and Claim Status
  • » Plan Benefits
  • » Deductibles
  • » Electronic Claims Submission to Smart Data Solutions using Payer Number CAPHP
  • » Sample Member ID Card


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Fax Back

Call our automated system to have claims, eligibility, and benefits information faxed to you.

Dial 800-661-7683

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Frequently Asked Questions

Where can I find online claims status and eligibility?

You may check claim status and eligibility online by clicking the Provider Portal.

What is the process of filing claims electronically?

Electronic claims for providers should be submitted by using EDI Payer ID CAPHP.

What is the claims address?
Caprock HealthPlans
PO Box 21548
Eagan, MN 55121-0548

Is there a different phone number for Precert?

Yes, Hines and Associates 888-819-3775

What is the filing deadline?

Groups may vary in their individual filing limit. The fax back system will include the filing limit information for each patient.

How do I determine if I am in-network with your PPO?

Caprock HealthPlans is a third party administrator (TPA) and does not house network information. Please contact the network directly for additional information.

How do I correct my address in your system to insure my payment is sent to the correct address?

You may send a W-9 to the following address. Make sure to include your contact name and phone number. If your remittance address is different please attach address information to W-9 form.

Caprock HealthPlan
PO Box 54139
Lubbock, Texas 79453-4139
Fax: 806-698-5823

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HIPAA

Compliance with our state and federal partners is essential to providing accurate, timely and comprehensive care to our members. Below is a short list of requirements (not all-inclusive) that physicians and providers should meet. Protected Health Information (PHI) under HIPAA's Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. For complete description of physician/provider requirements, visit the Department of Health & Human Services website at:
http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/index.html

National Provider Identifier (NPI)

The National Provider Identifier (NPI) is a Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Standard. An NPI is a unique identification number for covered health care providers and is mandated by HIPAA on all (electronically) filed claims.

Important Note

Please note benefit verification is based upon the patient information in our records as of this date. It is NOT a guarantee of payment. Benefits are subject to all plan provisions, regarding medical necessity, coordination programs, as well as patient eligibility on dates of service.

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