Claims Information

Claim Status

Providers can follow-up on the status of claims submitted to Seaside Health Plan on our Web Site. If you are a Registered Provider, simply click here to log in. If you are not a registered Provider, complete the registration form to request access and create your own personal login and password. If you have any questions or need assistance contact our Claims Inquiry Department at (855) 367-7747 and a Claims Inquiry Representative will assist you.

Non-Contracted Provider Fee Schedule for Commercial Members

Seaside Health Plan utilizes the Fair Health’s Fee Estimator to establish Usual and Customary Rates (UCR).  Seaside Health Plan pays the lessor of the provider’s billed charges or 50% of the allowable rate through Feeestimator.org.

Non-Contracted Provider Fee Schedule for Medicare and Medi-Cal Members

Seaside Health Plan utilizes the Fair Health’s Fee Estimator to establish Usual and Customary Rates (UCR). Seaside Health Plan pays the lessor of the provider’s billed charges or Medicare / Medi-Cal allowable rates through Feeestimator.org.

Claim Submission: Electronic Claims

Electronic Claims are claims submitted electronically through a Plan-approved electronic billing system software vendor or clearing-house. Completion of electronic claim submission requirements can speed claim processing and prevent delays.

If you use EDI, you must include:

  • Billing Provider Name
  • Rendering Provider
  • Legal Name
  • License Number (if applicable)
  • Medicare Number (if applicable)
  • Federal Provider Tax ID Number
  • Medi-Cal ID Number (if applicable)
  • National Provider Identifier (NPI)

We cannot be responsible for claims never received. Providers must work with their vendors to ensure files are successfully submitted to us. Failure of a third party to submit a claim to us may risk the Providers claim being denied for untimely filing if those claims are not successfully submitted during the filing limit.

Contact our Seaside Health Plan Claims Department at (855) 367-7747 or send an e-mail to SeasideClaim@MemorialCare.org:

  • To learn more about EDI and how to get connected
  • For a current list of approved software vendors and clearing-houses
  • To submit claims electronically if your system is compatible
  • For technical assistance and support (for existing accounts, e-mail SeasideClaim@MemorialCare.org)

Claim Submission: Paper Claims

Paper claims are scanned for optimal processing and recording of data provided; therefore, even paper claims must be legible and provided in the appropriate format to ensure scanning capabilities. The following paper claim submission requirements can speed claim processing and prevent delays:

  • Use the appropriate form type for submission
  • Use black or blue ink; do not use red ink, as the scanner may not be able to read it
  • Use the Remarks field for messages
  • Do not stamp or write over boxes on the claim form
  • Send the original claim form to us and retain the copy for your records
  • Separate each individual claim form. Do not staple original claims together, as we would consider the second claim an attachment and not an original claim to be processed separately
  • Information is typed within the designated area of the field. Be sure the type falls completely within the text space and is properly aligned with corresponding information. If using a dot matrix printer, do not use draft mode since the characters generally do not have enough distinction and clarity for the optical character reader to accurately determine the contents

Attachments to Paper Claims

Some claims may require additional attachments. Be sure to include all supporting documentation when submitting your claim.

Paper Claim Submission Mailing Address

Seaside Health Plan
PO BOX 830459
Birmingham, AL 35283

 

Provider Dispute Resolution