We’re glad you’re in the Network

Encore is the health network that cares. We provide access to doctors your patients know, and hospitals they trust

As a provider, we know that you are always looking for efficient ways to manage patient claims. That’s why Encore entered into EDI relationships with  and . Both electronic filing systems allow claims to get repriced more quickly, efficiently, and accurately.

Emdeon

Your office may submit your HCFA and UB92 claims electronically to Encore via Emdeon using our Payor ID number (35206) for only the employer groups that require Encore repricing. All employers utilizing Encore repricing will include the following address on their member’s identification cards:

Encore Health Network
8520 Allison Pointe Blvd, Ste 200
Indianapolis, IN 46250-4299

Only the above claim filing address should be sent electronically through Emdeon. All other claims should be mailed to the appropriate claim filing address as indicated on the identification card. Claims received from the above P.O. Box numbers will be repriced and forwarded to the contracted insurance company or third party administrator.
All electronically submitted claims must contain the below information. Claims without this information may possibly be returned electronically and will delay claim processing.

  • Policy and/or Group Number
  • Name of Employer
  • Name of Insurer
  • Insured’s Name, Social Security Number and Address
  • Member’s Name and Date of Birth

Note: Other payors also accept electronic claims. Either the identification card will supply the Payor ID or you can contact your clearinghouse for the unique payor ID.

If you are not currently submitting claims electronically and are interested in learning how, please contact Emdeon Customer Support at 1-800-845-6592.

TKSoftware

Encore offers TKSoftware as an alternative, cost-effective vendor for electronic claims submission to our contracted providers with TKSoftware. TKSoftware works as a clearinghouse for claims transmission much the same way Emdeon does. Using TKSoftware allows you to send claims directly to Encore. Better yet, when you submit directly to Encore using TKSoftware there’s no charge!

Advantages to submitting claims directly to Encore:

  • You shorten your reimbursement cycle, which means you get paid faster!
  • You eliminate per claim transaction costs because when you submit to Encore there’s no charge!
  • When you submit directly, you are provided with a website to track your claim submission.

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My Payor Download



If you have any questions, please contact webmaster@encoreconnect.com
Special Authorization is required to access the Payor Updates.
Please contact one of the following Account Executives for access:
· Holly Joyce at (317) 621-4263 or hjoyce@encoreppo.com, or
· Kevin McShay at (317) 621-4264 or kmcshay@encoreppo.com

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Notice

Encore has entered into a new arrangement for chiropractic services with HSM, Inc. HSM, Inc., a Minnesota-based specialty network services organization, will administer the chiropractic network for our Encore and Encircle service areas.

HSM will directly hold contracts with all participating chiropractors; therefore, there are some changes of which you should be aware. Regarding billing, chiropractors will now send their claims directly to HSM. HSM will collect the data in their system, including treatment plans for case management, and forward claims to the appropriate Encore payor. The payor will send all payment directly to HSM, who will in turn reimburse the chiropractor according to the negotiated rates.

If you are interested in becoming a participating chiropractor in the Encore Health Network, please contact HSM at 800-432-3640 or visit their web-site at www.hsminc.com.

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Current Worker's Comp Payors

Arete USA D/B/A The Covenant Companies
HealthSmart
HFN, Inc
Indiana University
InterPlan Health Group
IU Health Plan
MCMC LLC
ASU Group
Major Hospital
ACS CompIQ Corporation, A Xerox Company

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Payor and Provider Resources

Payors please contact Account Executive Kevin McShay at (317)621-4264 or kmcshay@encoreppo.com for access.

For any provider issue, please contact Provider Contracting Coordinator, Tina Bilodeau at (317)621-4269 or tbilodeau@encoreppo.com.