Provider
IMPORTANT ANNOUNCEMENT
Effective March 23, 2012, New NDC Billing Requirements
In compliance with the Centers for Medicare and Medicaid Services (CMS), CeltiCare Health Plan of Massachusetts, Inc. ™ (CeltiCare) requires the 11 digit National Drug Code Number (NDC) reported on all qualifying claim forms when Injectable drugs are administered in the office or outpatient setting; this requirement excludes applicable vaccines/immunizations related to Health Check services.
Please Note: Effective March 23, 2012, the NDC number submitted to CeltiCare must be the actual NDC number on the package or container from which the medication was administered. Do not bill for one manufacturer’s product and dispense another. Also, refrain from reporting 99999999999 to bypass edit. Failure to submit the exact applicable NDC number administered to the member will result in front-end rejection and/or denial of claims.
Detailed guidelines regarding NDC reporting requirements is available for your reference, click here.
Providers
Massachusetts leads the way in providing access to care. CeltiCare is proud to be a part of this progressive health care system. That’s why we are committed to partnering with physicians that will provide the highest quality of care and value to our members.
The foundation of CeltiCare’s integrated health care delivery model is the member-PCP relationship, the “Medical Home,” which is supported by our innovative care management programs. Our proven ability to strengthen the Medical Home for our members will increase the utilization of preventive services and reduce member reliance on the emergency room; increasing continuity of care and resulting in better health outcomes for Commonwealth Care members.
We hope you and your staff find the tools and resources you need to provide the highest quality of care to your patients, our members. To find out more about the programs and services available to our members please visit the Stay Healthy section.
Become a ProviderWe partner with physicians, hospitals and other providers to ensure that each member gets the right care, at the right time, in the right setting. In this section you will find important information on how to become a provider, including our credentialing forms.
Electronic TransactionsSpend less time on the phone or standing at the fax machine. Our electronic transaction (EDI and Payformance) capabilities will save you time and money while producing faster results.
PharmacyOur pharmacy program provides access to pharmaceutical services for our members and educates providers on improving the quality of patient care. Learn more about US Script and Caremark. You will also find pharmacy enrollment forms.
QI ProgramThe Quality Improvement (QI) Program is to addresses both the quality and safety of services provided to CeltiCare’s members. We follow HEDIS standardized performance measures and adopt clinical practice guidelines.
Secure Web PortalSign up for our secure web portal for helpful resources and to help eliminate administrative hassles so you can focus on what you to do best – providing care for your patients, our members!
