Frequently Asked Questions
1. What is Windsor Medicare Extra's Provider Services Phone Number?
2. What is Windsor Medicare Extra's Claims Address?
3. What is Windsor Medicare Extra's Electronic Claims Filing Number?
4. What is Windsor Medicare Extra's Claims Appeals Address?
5. What is Windsor Medicare Extra's Medical Appeals Address?
6. How do I verify eligibility or claims status on a Windsor Medicare Extra Member?
7. Do I have to have a referral from the member's Primary Physician before seeing the patient?
9. Is a Doctor's office required to obtain an authorization for any lab work done in his office?
10. What procedures and services require an authorization?
11. Do you carve out Behavioral Health Services?
12. Do you carve out routine vision services?
13. Does a CT or MRI require Authorization if ordered by a Specialist and not a PCP?
15. Does a member have to choose a Primary Physician?
16. For members who choose a Primary Physician, why is it not on the card?
17. Do the Formularies both include all Oral and Injectable drugs?
18. What does it mean in the formulary when it says "Part B Primary"?
19. What is the Windsor Credentialing Policy?
What is Windsor Medicare Extra's Provider Services Phone Number?
866-270-5223
What is Windsor Medicare Extra's Claims Address?
Windsor Medicare Extra Claims
P. O. Box 269025
Plano, TX 75026-9025
What is Windsor Medicare Extra's Electronic Claims Filing Number?
62153
What is Windsor Medicare Extra's Claims Appeals Address?
Windsor Medicare ExtraAttn: Claims Appeals
7100 Commerce Way
Suite 285
Brentwood, TN 37027
What is Windsor Medicare Extra's Medical Appeals Address?
Windsor Medicare ExtraAttn: Medical Appeals
7100 Commerce Way
Suite 285
Brentwood, TN 37027
How do I verify eligibility or claims status on a Windsor Medicare Extra Member?
On our webpage or by calling Provider Services at 866-270-5223.
Do I have to have a referral from the member's Primary Physician before seeing the patient?
No referral is required. Our members may self-refer to any in-network participating specialist.
Where do I send Lab work?
Lab work can be sent to Labcorp, Quest or any contracted participating laboratory or participating Hospital laboratory as shown on the Provider Quick Reference Sheet.
Is a Doctor's office required to obtain an authorization for any lab work done in his office?
Physician offices may perform laboratory services for which they are CLIA certified.
What procedures and services require an authorization?
Please click on Prior Authorizations to view our Prior Authorization Grid.
Do you carve out Behavioral Health Services?
Yes, to MHNet and Advantage Behavioral Health.
MHNet's phone number is 800-835-2094.
Advantage Behavioral Health's phone number is
866-276-4560
MHNet contracted providers need to mail claims to:
MHNet Behavioral Health
P.O. Box 209010
Austin, TX 78720
Advantage Behavioral Health contracted providers need to mail claims to:
Windsor Medicare Extra
P.O. Box 269025
Plano, TX 75026-9025
Do you carve out routine vision services?
Yes, to OptiCare. Their phone number is 800-840-7032.
Their claim address is:
OptiCare
P.O. Box 7548
Rocky Mount, NC 27804
Does a CT or MRI require Authorization if ordered by a Specialist and not a PCP?
Yes. Authorization is required regardless of who orders the CT or MRI.
Is an ICD-9 code required to obtain authorization or can a narrative description be provided instead?
An ICD-9 code is not required, but it is preferred and will speed the authorization process.
Does a member have to choose a Primary Physician?
Members are not required to choose a primary physician, but are encouraged to do so. A member may choose a Primary Care or a variety of Specialists as his or her Primary Physician.
For members who choose a Primary Physician, why is it not on the card?
Windsor Medicare Extra plans are all open access. Referrals are not required to see a specialist; however, members must remain in network when referred to another physician.
Do the Formularies both include all Oral and Injectable drugs?
Yes, the Formularies are all inclusive.
What does it mean in the formulary when it says "Part B Primary"?
This means that these drugs fall under the medical benefit structure, not the Part D co-payment structure.
What is the Windsor Credentialing Policy?
Windsor Medicare Extra follows NCQA Guidelines.
