Coventry Health Care

Basics for Medical Billers

Coventry Health Care, Inc. operates a number of health plans, insurance companies, and worker's compensation service companies in all 50 states. Medical billers are likely to need to submit claims to this company. They provide a  convenient web portal to do most of these tasks.

There are many different health plans which fall under the Coventry umbrella, ranging from Group Health Plan to American Postal Workers Union. From preauthorization, to claim benefits, to corrected claims and refunds, what should you know about Coventry and how can you locate the specific information you need? Let's begin by talking about which plans are included, how to find general information, and where you can direct your specific questions to get the answers you need.

If you are looking for general information to manage the complex medical insurance system, being by checking out an overview of health insurance plans.


Plans Included Under Coventry Health Care

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As with many current health insurance companies, Coventry Health Care is a large company which includes many smaller plans. Some (but not all) of these include: 

  • Coventry Health Care National Network
  • First Health Network
  • Mail Handlers Benefit Plan
  • Altius
  • Carelink
  • Coventry Health Care of Delaware, Florida, Georgia, Iowa, Kansas, Louisiana, Nebraska, Nevada
  • Coventry Health and Life of Oklahoma, Tennessee
  • Coventry Missouri
  • Group Health Plan
  • HealthAmerica/HealthAssurance
  • PersonalCare
  • Southern Health Services
  • University of Missouri
  • WellPath
  • Association Benefit Plan
  • Foreign Service Benefit Plan
  • Rural Carriers Benefit Plan
  • Strategic Outsourcing, Inc
  • American Postal Workers Union (APWU)
  • First Health Life & Health Ins. Co.

General Information on Coventry Health Care

Health insurance helps patients get the medical care they require

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The best way to locate general information on health care billing with Coventry, refer to the Contact Grid located in Section 6 of the provider manual.

For Customer Service Issues please check for the Customer Service Phone Number listed on every member ID Card. This Department will be able to help you with the issues listed below as well as many other concerns.

  • Corrected Claims Issues
  • Itemized Bills
  • Timely Filing
  • Adjudication Issues
  • Requests for EOB and RAs
  • Authorization Requirements
  • Check and Refund Issues
  • Benefit and Member Issues
  • Initial Balance Billing Calls
  • New Provider Inquiries
  • Provider Manual Requests
  • Non-Par Demographic changes
  • NPI Questions

For Coventry National Customer Service questions call the telephone number located on the back of the member ID card.


Eligibility, Benefits and Claim Status

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If you are wondering if a particular procedure or provider is covered (eligibility), the amount of coverage (benefits), or are interested in learning that status of a claim (claim status), there are three ways to get this information.

  1. Contact the phone number listed on the member's ID card.
  2. Through Coventry Health Care's online provider portal at
  3. Through Emdeon Office.


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Services typically requiring preauthorization  include hospital inpatient or observation care, selected outpatient surgery (regardless of type of setting), high cost radiology (such as CT, MRI, IMRT, Bone Density, Whole Body or PET Scans), DME/Prosthetics/Orthotics, Home Care, Pain Management, Rehabilitation (Cardiac/Pulmonary/PT/OT/Speech), Sleep Studies, and services related to Infertility or Transplants.

How to Submit a Precertification Request

Preauthorization requests can be submitted through Coventry Health Care's online provider portal at

For specific questions, contact the preauthorization number listed on the member's ID card.


Billing Information

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There are three primary ways in which bills may be submitted:

  1. Electronic claims can be submitted through Coventry Health Care's online provider portal at
  2. Electronic claims can be submitted through Emdeon's clearinghouse.
  3. Paper claims can be submitted to the Coventry Health Care's claims mailing address listed on the member's ID card.

Secondary claims can be filed in the following ways:

  • Submit electronically.
  • Paper claims can be submitted with the primary payer's EOB.
  • Include adjustment amounts at both claim level and service line level (if available).
  • Include adjustment reasons such as contractual obligation, deductible, coinsurance, or others. Use the codes furnished by the primary payer's remittance.
  • Primary payer paid amount at both claim level and service line level (if available).

Timely Filing Requirements

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Timely filing limits are specified in the provider agreement.

Since this information can change with time or vary with the particular company, make sure to look through the provider agreement for the most recent requirements.


Corrected Claims

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When making changes to previously paid claims, submit corrected claims electronically.

Update the Claim Frequency Code with:
7 = Replacement of a prior claim.
8 = Void/cancel of a prior claim.



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If you need to handle a health insurance overpayment, submit a corrected claim. Coventry Health Care will recover/recoup the overpayment which will be reported on an ERA with a reversal of the incorrect claim adjudication, followed by the corrected adjudication of the claim.

Refunds due to existing credit balances can be sent to:

Refer to Coventry's Contract Grid located in Section 6 of the provider manual.


Appeal Information

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 To appeal denied medical claims these claims can be reconsidered through Coventry Health Care's free online provider portal at or contact the phone number on the member's ID card for information.

Go to the Provider section of the Coventry websites, under Electronic Solutions, to view EDI Documentation and other pertinent information and options that are available to you.

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