Provider FAQs

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How do I update my practice information after a change has occurred to ensure accurate information in the Provider Directory and on this website's Provider Locator?
Provider practice location information can be updated three different ways:
  • By filling out the online Provider Information Change form
  • By calling our Network Management Department at 866.498.4773
  • By faxing location information and W-9 forms (In the case of a tax identification number change) directly to 610.757.1392
  • By emailing networkmanagement@devonhealth.com.

How do I get insurance information from the patient?
Each Devon Health Services patient carries a medical identification card that has all the information necessary to file and submit claims. The name and the logo of the insurance carrier/administrator is clearly stated on the front of each card. Devon Health Services is the provider network only and does not pay claims.

How do I determine the patient's insurance company or benefit administrator?
The name and logo of the patient's insurance company or benefit administrator are printed in bold type on the front of the member's medical identification card.

Do patients have any financial responsibility?
A patient's financial responsibility depends on his/her benefit plan and will vary from patient to patient. Applicable co-payments are listed on the patient medical identification card and should be collected up front. Should the patient have a deductible and/or coinsurance the explanation of benefits (EOB) that is issued by the insurance carrier/administrator will state the amount that the patient is responsible for. The provider can bill the patient for that amount.

What encounter fees (co-payments) should I collect from the patient at the time of service?
If a patient has an encounter fee (co-payment) for an office visit, the amount will be printed on the patient's medical identification card. This fee can be collected from the patient at the time of service.

Who do we contact about benefit coverage and eligibility?
Devon Health Services does not design insurance plans or coverage therefore providers should call the insurance carrier/administrator to check benefit limitations and coverage. This number is listed on each patient's medical identification card.

Do patients need a referral?
Devon Health Services is a Preferred Provider Organization and patients do not need to obtain referrals from their primary care physicians.

Do patients need precertification?
For programs that require precertification, necessary information is printed on the member's medical ID card along with a phone number to call for additional questions.

How do I file a claim?
Devon Health Services follows standard Medicare claims submission guidelines. Claims should be submitted on HCFA for physician billing or UB 04 for hospital/ancillary billing.

Where do I submit claims?
The claims address, along with the phone number for claims inquiries, is printed each patient's ID card. Claims addresses will vary depending on the patient's employer. The patient's medical identification card is the best source for this information.

What should I do if I have outstanding claims or claims denied as out-of-network?
Devon Health Services does not pay claims; however, we have established procedures to help our providers get their claims paid correctly and in a timely manner. Should you have any problems getting claims paid correctly or processed as in-network, you are welcome to contact Devon Health Services' Provider Relations Department for assistance. In order to help, we will need to get a copy of the HCFA /UB 04 and the explanation of benefits, if applicable.

Additional Questions? Contact Provider Relations toll-free by calling 866.498.4773 or email networkmanagement@devonhealth.com.