• Welcome Providers!

    Thank you for working with Clear Spring Health and helping to give our members a clear path to healthy aging.

    Your relationship with your patients is an important aspect of their health and well-being. Clear Spring Health has tools and resources to help support you in their care. The strength of our provider and physician networks give your patients the freedom to economically achieve their healthy aging goals.

    As a participant in our network, you join a vast group of providers dedicated to providing quality Medicare Advantage Plan options to seniors in select counties of Colorado, Illinois, North Carolina and Virginia, plus Georgia and South Carolina.

    Join Our Network

    If you are interested in joining our network, please complete the form below and a representative will be in touch.

    Provider Resources
    • Referrals and Precertification
    Referrals and Precertification

    Referrals and precertification apply to benefit plans that include those requirements. Please review the attached document to learn more about our guidelines.

    • Appeals
    Appeals

    Please submit your appeal request, including all applicable documentation to:

    Clear Spring Health
    Appeals and Grievances
    P.O. Box 4048
    Scranton, PA 18505-9875

    • Claims/Reimbursement
    Claims/Reimbursement

    Clear Spring Health values the quality care that you give to our members and it is our goal to provide prompt reimbursement for those services. A key factor in timely claim processing is correct submission. We are committed to helping you submit a claim correctly the first time which will increases your cash flow, prevents costly follow-up by your staff and reduces unresolved claims for members.

    Clear Spring can accept claims electronically through Change Healthcare. Clear Spring encourages practitioners to take advantage of our electronic claims processing capabilities. Submitting claims electronically offers the following benefits:

    • Faster Claims Submission and Processing
    • Reduced Paperwork
    • Increased Claims Accuracy
    • Time and Cost Savings

    For submission of professional or institutional electronic claims for Clear Spring Health, the Clear Spring Health Payer ID is 85468.

    Paper claims can be mailed to:

    Clear Spring Health
    P.O. Box 491
    Park Ridge, IL 60068-0491

    • Notices and Newsletters
    Notices and Newsletters

    You need to stay “in-the-know” with the latest news in this constantly changing world of health care. Clear Spring Health is here to provide you with news and updates from us as well as the latest breaking stories from the health care industry, Centers for Medicare (CMS), and the Centers for Disease Control (CDC). We are here to keep you informed.

    • FDR Annual Compliance Attestation Form
    FDR Annual Compliance Attestation Form

    First Tier, Downstream and Related Entities (FDR) Annual Attestation Form

    Centers for Medicare and Medicaid Services (CMS) and other federal and state entities require Clear Spring Health (CSH) to have oversight and monitoring of the First Tier, Downstream, and Related Entities (FDR). Clear Spring Health is committed to ensure the FDRs are in compliance with applicable laws and regulations as published in the Title 42 of the Code of Federal Regulations, Parts 422 and 423 and sub-regulatory guidance published in both Pub. 100-18, Medicare Prescription Drug Benefit Manual Chapter 9, and in Pub. 100-16, Medicare Managed Care Manual Chapter 21.

    This attestation form is to facilitate the oversight and monitoring for FDR compliance with CMS and other federal and state regulators program requirements. The annual attestation must be signed by an individual with the authority to attest the accuracy and completeness of the information provided.

    Please complete and submit the attestation form to Clear Spring Health Compliance Department
    • Quality Improvement
    Contact Us

    Last Updated on October 11, 2020, 11:48 pm CDT

    Y1045_MK_W003-092520

    Clear Spring Health, PO Box 278530 Miramar, FL 33027 ©Copyright 2020 Clear Spring Health. All rights reserved.


    Clear Spring Health has a contract with Medicare to offer PPO, HMO, and PDP Plans. Eon Health has a contract with the Georgia Medicaid program and a contract with the South Carolina Medicaid program. Enrollment in these plans depends on contract renewal.

    To learn more, please call (877) 364-4566 TTY users should call 711. Our office hours are October 1 – March 31, seven days a week, 8:00 a.m. – 8:00 p.m. and from April 1 – September 30, Monday through Friday, 8:00 a.m. – 8:00 p.m. (you may leave a voicemail Saturday, Sunday and Federal Holidays).

    Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.Llame al 1-877-364-4566 (TTY: 711)