Benefit Coverage & Administrative Information

   
• Acknowledgement of Hysterectomy Information (English)
• Acknowledgement of Hysterectomy Information (Spanish)
• DOH Court Order Medical Care Form
• Express Scripts Electronic Prior Authorization
• PA Requirement List Eff. 9/1/2018
• PA Requirements for Specialty Services Eff. 6/1/2018
• Past PA Requirements
• PCP Change Form
• Preauthorization/Referral Form
• Prior Authorization Form for Prescriptions
• Provider Quick Sheet Phone Guide
• Sterilization Consent Form (English)
• Sterilization Consent Form (Spanish)
• Vaccine Order Sheet (8/16/07)
• Vaccine Order Sheet (5/4/16)
• YourCare Provider Billing Overview
• YourCare Provider Manual
• YourCare Option Plus Provider Manual

• Beacon YourCare Provider Orientation
• YourCare Option Plus Provider Manual

• Claim Adjustment Form
• Claim Dispute Form
• Inpatient Claim Review Form

• Locum Tenens
• Demographics Change Form
• Non-Credentialed Health Care Practitioner Application
• Practitioner Credentialing and Termination Policy
• Practitioner Enrollment Application Form
• Practitioner Termination Request
• Provider Roster

YourCare Health Plan has partnered with InstaMed, the leading healthcare payments network, to offer free Electronic Remittance Advise (ERA) and Electronic Funds Transfer (EFT).  ERA/EFT results in faster payment, reduced administrative costs, and increased efficiency.

Get paid faster and reduce costs by eliminating paper checks and remittance advice by receiving ERA/EFT with InstaMed.

• Get paid faster with claims payments directly deposited into your bank account
• Automate payment posting to streamline processes
• Automate reconciliation of payments and remittances
• Access reporting 24/7 to simplify your workflow

Enroll with InstaMed

Option 1:

• Enroll online and start receiving benefits immediately

Option 2:

• Download and complete the Network Funding Agreement
• Attach a voided check
  • Fax or mail the form to InstaMed
  • Fax: 877.755.3392
  • Mail: P.O. Box 58790 Philadelphia, PA 19102

This will allow your practice to receive electronic payments for claims submitted to YourCare Health Plan