Providers

As a healthcare provider, you can access our fax back system and receive a fax printout that will verify member eligibility, check status of a medical, dental, or vision claim, and verify benefits by calling our automated system at 1-800-472-7130 extension 5590.

Medical Policies

TCS has adopted the UniCare medical policies for application to its members. These policies are merely to assist in administering plan benefits.  Benefit determinations are subject to the contractual limitations of a covered person’s benefit plan.

HIPAA Contingency Information

Total Claims Solution Contingency Plan for Electronic Transactions after the 10/16/03 HIPAA Compliance Deadline.

Procedure for Overpayment Requests
Information regarding the TCS Procedure for handling overpayments to Providers.

Claims Category Codes

The list of claims categories where we may routinely require submission of Clinical Information before or after payment of a claim.

Claim Submission and Formats

Information regarding submission of claims and formats.

Consent for Release of Clinical Information
Individual Authorization Form

Individual Authorization Form - Psychotherapy Notes

Precertification Requirements
Minimum Requirements for Precertification

Claims Processing Edits
Significant Edits

Limited Code Combinations for Modifiers 25 and 59

Provider Internal Appeals Process
Claim Correspondence - Claim Reconsideration Request

Claim Reconsideration Request Form

Physician Advisory Council
Information about our Physician Advisory Council

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