Each family member, regardless of age, receives a unique CoOportunity Health ID card and number. The ID numbers are not necessarily sequential for family members.

To avoid denials, file claims using the patient's name and ID number.

Need to find an ID number? 

1. Visit coOportunityhealth.com/provider.
2. Log on to our secure Eligibility Inquiry application [or register for access - see below].
3. Enter the patient name and birth date.

Register for Access to Our Secure Provider Website

To register for access to our secure Provider website, visit coOportunityhealth.com/provider. 

• Receive instant access using a claims check number and your NPI.
   OR
• Request a PIN using your taxpayer ID number.  The PIN is sent by mail.

Medical Policy Update Effective January 1

On February 6, 2014, we updated our Musculoskeletal Treatment [Chiropractic Services] medical policy.  Note: 

• Revised definition of covered indications includes:
• Diagnosis by physical examination and testing that is within a chiropractor's scope of practice and otherwise covered by CoOportunity Health.
• Change effective with our first date of our coverage: January 1, 2014.
• Notice posted on the new Medical Policy Updates page and under our News page's Medical Policy tab.

Future medical policy updates will be shared in our Provider Alert, and posted on our News page and as an update from our Medical Policy page. Midlands Choice will also post a link to our Provider Alert on their website under News & Resources.

Use Back of ID Card to Locate Claims Filing Information

CoOportunity Health contracts with HealthPartners Administrators, Inc. to provide claims processing, medical management and certain other administrative services on our behalf.

Because you will not file our claims with Midlands Choice, you should enroll with HealthPartners for your Electronic Data Interchange [EDI] needs. This enrollment is for electronic transactions only.

For clearinghouse information and Payer IDs, visit coOportunityhealth.com/eservices. Please confirm this information with your vendor or clearinghouse prior to submission. Even if your clearinghouse is not listed, your vendor can redirect claims through a HealthPartners approved clearinghouse.  

How to Access Commonly Used Forms

Check the following pages for forms at coOportunityHealth.com/provider:

• Forms [see Quick Links]
• General tab: Claims-related forms [includes Adjustment and Appeal forms], Hospital Notification form, and Clinical Program Referral form
• Behavioral Health tab: Prior Authorization Requests, Access to Care Management Programs
• Medical Policy tab: Prior Authorization forms; includes the Pharmacy Prior Authorization Exception Form
• Medical Policy/Coverage Criteria [see Quick Links]
• Prior Authorization forms accessible from any policy that requires a prior authorization
• Pharmacy Policies [see Clinical Resources tab]
• Prior Authorization and Formulary Exception Form
• New Drug Request Form

Preventive Services

When provided by an in-network provider, services billed as preventive/routine care are covered at 100 percent of the allowed amount and are not subject to deductibles or other member cost-share amounts.

To locate payable preventive services, visit the following medical policies:

• Preventive Services - Adult
• Preventive Services - Children and Adolescents 


Three-for-Free

Some members have a Three-for-Free benefit.  This benefit waives each covered person's office visit copayment for three nonpreventive office calls each calendar year.  Things to know:

• The benefit applies to the first three office visit CPT® codes processed by CoOportunity Health.
• Other services provided during the visit, such as a laboratory service, are subject to applicable deductibles or other cost-share amounts.
• Office visits submitted by primary or specialty care providers and/or outpatient behavioral health providers are eligible.
• Our secure Eligibility eTool identifies whether or not a member has the Three-for-Free benefit.

Read more [see Features tab]... 

Webinars

For more information about CoOportunity Health, visit coOportunityhealth.com/provider.