Provider Portal Overview
Provider Portal - Basics
 Website address: www.countycare.com/providers/login
 Log In Access and User Set Up is TIN driven
 On-site administrator access will be set up by Valence Health/County
Care
 Requires completion of access form
 Administrator will issue usernames/passwords to office/practice staff
 Users will have access 24/7 to utilize the system at their convenience.
 Releases (updates) occur every 4-6 weeks
 Prior notice will be posted
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Portal Access Form – For Admins ONLY
• Basic form, basic
information needed:
– Demographic information for onsite administrator
– TIN(s) requesting access for
– Available for download at:
www.countycare.com/transition
• Once completed fax to:
312-637-3114
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Provider Portal Overview
Functionality:
 Submit and View Prior
Authorization Status
 Check Prior Authorization
Requirements by CPT Code
 Access Key Documents and
Forms
 Member Eligibility (Effective
Date/PCP Assignment)
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Provider Lookup
Claims Status Search
View EOP
Provider Rosters
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Provider Portal Log In Page
 Access the Provider Portal via countycare.valencehealth.com
 Save to your browser Favorites – easy access
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Enter Your “Login ID”
Enter your “Password”
Click the “Sign In” Tab
If you forget your password,
click “Forget Password” and
enter the answer to your
security questions to obtain
instructions for changing your
password
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Log In Procedures
 After a new user has been created in the provider portal, the user will receive an email
which contains the user id, a temporary password and a link to the provider portal.
 The user will be immediately prompted to change the temporary password to a
permanent one.
NOTE: Passwords expire every 90 days, users will receive an email to remind them to change
their passwords when they expire. Once the user has successfully created a new password,
they will receive a prompt to the login screen to log into the system.
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Setting Security Questions
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Click on the “Profile” Link to
provide individual security
questions.
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During the first time login to the
provider portal, it is important for
users to set up security questions
and answers. These questions
will be presented to the user and
are required to reset the password
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Setting Up Practice Users (Practice Administrators)
Practice Administrators are responsible for creating Practice Users who submit referrals,
authorizations and view benefit statements. Practice administrators may also submit referrals.
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1. Click on the “Management link” at the top of the page
2. Select “Create User”
3. Provide the users’ first and last name, a unique email address and assign a user name. User
names must be between 6 and 20 characters in length
4. Click the “Submit” Tab. The user will be notified via email of their username and will receive a
temporary password once the user setup process is complete.
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Setting Up Practice Users – Assigning TINs and NPIs
Practice Users inherit the same Tax ID numbers (TIN). The National Provider
Identifier (NPI) Number is an individual identification number and is used to grant
access to the an individual Practice User within each TIN.
For minimal maintenance, the following best practice is prescribed:
1. Practice Admins – When creating Practice Users, choose “Inherit PA NPIs” for
each TIN in the Practice User’s profile.
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This ensures that when new NPIs
are added to a TIN through batch
provider file updates, the access to
the new NPIs will automatically be
granted for the users who have that
selection.
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Submitting Authorizations
1. To submit a request for prior authorization, click on the new authorization link located in
the blue header bar at the top of the page.
2. Complete the form with required information. Use the select buttons to locate the Patient,
Referring Provider (usually PCP), Referred To Provider and Referred To location.
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Submitting Authorizations (continued)
Use the “Select a Service” drop down
list to choose the appropriate “Type of
Service” being requested.
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Enter the correct date of service
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Use the find button(s) to search for the correct
diagnosis
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Select the looking glass tab to search for the correct
procedure codes (CPT).
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Click the “Add” button to enter the CPT code, multiple
CPT codes may be added by clicking the “Add”
button after each code is selected
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Enter the correct enter the # of days or services being
requested, (e.g., 12 for the # of PT visits)
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Submitting Authorizations (continued)
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Click the “Attach File” button to
attach clinical information or any
document(s) that provide details to
support the authorization request.
2.
Additional information or history may
be added in the “Comments/Clinical
History” free text field
3.
Check the “I Agree” box to agree to
the terms
4.
Click the “Submit Referral Request
tab to send authorization for review
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NOTE: Include as much clinical information as possible to support medical necessity.
If additional information is required the request for Prior Authorization will be delayed
while the necessary information is obtained.
Remember: You will never be told you submitted too much clinical information.
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Checking Authorization Status
Practice Administrators and
Practice Users may also check the
status of an authorization request.*
1. Click on “Authorizations” in the
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blue bar at the top of the Home
page to access the “Status” tab
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2. Search for the authorization by
Provider, Date Range, Member
ID, or Authorization Reference #
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3. Click on the “Search” tab to
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query and access the
authorization
4. The query results will appear at
the bottom of the page
*Only authorizations that include a TIN on the
User account will appear.
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Checking by CPT Code if Prior Authorization Required
A CPT code list of services
requiring prior authorization
can be accessed:
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1. Click on “Authorizations”
in the blue bar at the top
of the Home page
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2. Click on “ CPT Code List”
to obtain the pa service
code information
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Key Documents and Forms
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Key documents and forms may be
accessed:
1. Click on “Documents” in the blue
bar at the top of the Home page
2. The following documents will be
available including:
– Critical Incident Reporting Form
– EFT/ ERA Forms
– Quick Reference Guide
– Training Materials
– Other Reference Documents
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Checking Member Eligibility – Quick Reference
 ID Cards are not a guarantee of active member eligibility
 Provider Options for checking Member Eligibility
 Secure online provider portal: countycare.valencehealth.com
 Automated interactive voice response (IVR) member eligibility system
312-864-8200 or 855-444-1661
 Toll free Provider Service number & follow prompts to speak to representative (312864-8200 or 855-444-1661).
Provide the following:
– Member Name
– Member ID Number
– Member DOB
 State MEDI system at www.myhfs.Illinois.gov
 A member should not be denied services if their name does
not appear on the eligibility roster, contact Provider Services for further verification
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Viewing Member Eligibility in Portal - Search
Member Eligibility may be viewed (real time) in the Portal
1. Select “Eligibility Search” from the Menu bar
2. Choose “Eligible as of Date”, DOB and Last Name are required fields
3. Its best to leave the “Include Ineligible” on “Yes” to view member eligibility
4. Click the “Search” tab to obtain results
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Viewing Member Eligibility in Portal & Details
1. When you click on the Blue Member ID you will see member details including eligibility
2. Details include Family, Member ID, SSN, Gender, Address, Phone #s, Eligibility Dates,
Provider Info
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Provider Lookup Search Tool
1. Click on the “Provider Lookup link in the menu bar, and a new window will open
up
2. Search by Type, Location, Name, Gender,- other options
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Claim Status - Search
1. Search for Claims by clicking on the “Claims Search” menu bar link
2. Criteria for Search
 Provider and DOS or Claim Date
– May search all NPIs or for a specific NPI within the TIN
 Member ID
 Claims Reference #
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Claim Status – Search Results
1. Click on the “Search” tab to access claims
2. All corresponding claims will appear and include information such as Claim #, Type,
Member/Provider Name, DOS, Claim Status, and Payment Info
3. Click on the Blue Claim # for Claim details
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Claim Detail Status
1. Patient Information & Provider Name
2. Claim Information
 Claim #, Claim Type, Claim Status, Service Dates, Claim Amount, Received Date, Adjudicated Date
4. Financial Payment Information
 Payment Amount ,Check/EFT Trace #, Check/EFT Issue Date
5. Service Line Information and Claim Service Details
 # of Lines, DOS, Service ID, Procedure and Dx Codes, Rev Codes, Days/Units
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Viewing your Explanation of Payment (EOP)
1. Select EOP from the Statement drop down in the blue menu link
2. Use the From/To Date fields
3. Click the “Search Tab to access EOPs
 Dates will auto populate with the last month
4. Will show EOP #, Date of EOP, Paid To, and Check Number
5. Click on blue EOP # for detailed EOP – will open PDF image of EOP
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Panel Roster Information
1. Providers may access a list of members that have selected or have been assigned to the
physician as their PCP. The Panel Roster selection is located under the “Statements” Menu
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2. Under the users assigned TIN, a list of all
providers associated with the TIN will
appear.
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3. A total volume of members assigned to
each provider is available
* Providers may appear in the list more than
once depending on number of practice
locations registered.*
4. Click on the provider name to access their
members. A list of members assigned to
the provider and the member’s
demographic details will appear.
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Panel Roster Information
1. Providers may access a list of members that have selected or have been assigned to the
physician as their PCP. The Panel Roster selection is located under the “Statements” Menu
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2. Under the users assigned TIN, a list of all
providers associated with the TIN will
appear.
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3. A total volume of members assigned to
each provider is available
* Providers may appear in the list more than
once depending on number of practice
locations registered.*
4. Click on the provider name to access their
members. A list of members assigned to
the provider and the member’s
demographic details will appear.
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Quick Reference Guide – Key Information
In the Documents drop down, select “Quick Reference Guide – CountyCare” for a printable
1 page, 2 sided guide of your key numbers, addresses, and other provider information
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Questions
• Contact Provider Services at 312-864-8200, Option 5 for providers
• Visit our Provider website at http://www.countycare.com/providers
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