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Provider claims process with Sidecar Health: Reimbursement and submission guidelines

Provider claims process with Sidecar Health: Reimbursement and submission guidelines

The Sidecar Health approach to health insurance removes obstacles to getting and giving excellent care like pre-authorizations and formularies. Additionally, Sidecar Health plans do not utilize a network of providers. With a few exceptions noted below, our members pay providers directly for all healthcare services.

Members pay providers directly

  • If you submit a claim for a non-ER service, where the patient does not have Medicaid or Medicare coverage, and Sidecar Health does not have a contract with you, Sidecar Health will pay all eligible benefits to the patient.

Sidecar Health pays providers directly

  • Providers may submit claims to Sidecar Health for eligible members.
  • For any emergency room service, for patients with Medicare or Medicaid coverage, or when there is a contract between the provider and Sidecar Health, Sidecar Health will accept Assignment of Benefits and pay the provider directly.

Below you will find instructions on how to get reimbursed and how to submit a claim.

How to get reimbursed:

 

Patient experience

Sidecar Health reimbursement guidelines

No Surprises Act (emergency room)

Patient was admitted to your emergency room / you provided our member with services that apply to the No Surprises Act

Sidecar Health complies with the federal No Surprises Act and state surprise billing laws and reimburses providers directly for services in accordance with those laws.

Coordination of Benefits

Patient has Medicaid or Medicare as additional coverage and requires that we coordinate benefits

Sidecar Health supports Coordination of Benefits with other plans and reimburses providers directly for applicable services.

Contractual agreement

Patient is considered an eligible member under a contract that Sidecar Health has with you or the organization you are with

While Sidecar Health does not utilize a network of providers, we are open to having direct pricing and servicing contracts that follow traditional revenue cycle billing

How to get reimbursed:

No Surprises Act (emergency room)

  • Patient experience - Patient was admitted to your emergency room / you provided our member with services that apply to the No Surprises Act
  • Sidecar Health reimbursement guidelines - Sidecar Health complies with the federal No Surprises Act and state surprise billing laws and reimburses providers directly for services in accordance with those laws.

 

Coordination of Benefits

  • Patient experience - Patient has Medicaid or Medicare as additional coverage and requires that we coordinate benefits
  • Sidecar Health reimbursement guidelines - Sidecar Health supports Coordination of Benefits with other plans and reimburses providers directly for applicable services.

 

Contractual agreement

  • Patient experience - Patient is considered an eligible member under a contract that Sidecar Health has with you or the organization you are with
  • Sidecar Health reimbursement guidelines - While Sidecar Health does not utilize a network of providers, we are open to having direct pricing and servicing contracts that follow traditional revenue cycle billing

In all other circumstances, eligible benefits will be paid to the Sidecar Health member. All members are equipped with a Sidecar Health VISA benefit card to pay directly for covered services at their provider’s office. We encourage providers to collect payment from the patient at any time – including pre-service.

 

If instead you would like to be reimbursed by Sidecar Health, contact a Sidecar Health Provider Relations at provider@sidecarhealth.com to discuss a contractual agreement.

How to submit a claim to Sidecar Health:

Sidecar Health requires providers to use the CMS-1500 Form for all professional services and the UB-04 Form for facility services. Claims can be submitted to us by mail at:

 

Sidecar Health Insurance Solutions, LLC
440 N Barranca Avenue, Suite 7028
Covina, CA 91723
Attention: Claims Department

 

Claims can also be submitted electronically through our partnership with The SSI Group.

 

Payer Name: Sidecar Health
Payer ID: SDCAR
Transaction: 837i & 837p