Netsmart Payers Supported on Rendered Services Inbound Feed
Netsmart has the following relationships with payers (MCO’s and state Medicaid programs):
Contracted Direct Claims Submission - Netsmart is contracted by the payer to aggregate and submit claims. For these payers, Netsmart performs claims business rules checks.
Non-Contracted Direct Claims Submission - Netsmart submits claims to this payer (or their clearinghouse), but is not contracted with the payer. Netsmart does not perform any business rules checks for these payers.
Indirect Claims Submission - Netsmart gathers eVV data and sends to another party that submits claims to the payer. As an example, Netsmart submits visit data to HHA Exchange, who in turn submits claims to the payer.
Following is the list of Netsmart payers supported for 3rd party inbound processing and the relationship with each:
Text Code | Description | Notes |
AETN | Aetna of Florida | Contracted Direct Claims Submission |
AHCA | Florida Medicaid (AHCA) | Contracted Direct Claims Submission |
ANTH | Simply DBA Clear Health Alliance of Florida | Contracted Direct Claims Submission |
CCPN | South Florida Community Care Network (CCP) | Contracted Direct Claims Submission |
FCCO | Florida Community Care/Independent Living Systems | Contracted Direct Claims Submission |
FLMA | Magellan Complete Care LLC of Florida | Contracted Direct Claims Submission |
UHTH | UnitedHealthcare of Florida | Contracted Direct Claims Submission |
ACBA | Florida Medicaid (AHCA) Behavior Analysis | Contracted Direct Claims Submission |
FLLH | Sunshine Health Little Havana of Florida | Indirect Claims Submission (HHAX) |
FLSF | Sunshine State Health Plan Inc. (Foster Care) of Florida | Indirect Claims Submission (HHAX) |
HUMA | Humana Medical Plan of Florida | Indirect Claims Submission (HHAX) |
MOLF | Molina Healthcare of Florida | Indirect Claims Submission (HHAX) |
SUNS | Sunshine State Health Plan Inc. of Florida | Indirect Claims Submission (HHAX) |
WELA | Wellmerica of Florida | Indirect Claims Submission (HHAX) |
WELC | WellCare of Florida | Indirect Claims Submission (HHAX) |
AETV | Aetna Better Health of Virginia | Non-Contracted Direct Claims Submission |
ANTV | Anthem Healthkeepers Plus BCBS of Virginia | Non-Contracted Direct Claims Submission |
MAGV | Magellan Complete Care of Virginia | Non-Contracted Direct Claims Submission |
MEDV | Virginia Medical Assistance Program | Non-Contracted Direct Claims Submission |
OPTV | OptimaHealth of Virginia | Non-Contracted Direct Claims Submission |
UHTV | United Healthcare of Virginia | Non-Contracted Direct Claims Submission |
VAKA | Kaiser Permanente of Virginia | Non-Contracted Direct Claims Submission |