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. How do I verify eligibility or claims status on a Windsor Medicare Extra Member?
5. Do I have to have a referral from the member's Primary Physician before seeing the patient?
7. Is a Doctor's office required to obtain an authorization for any lab work done in his office?
8. What procedures and services require an authorization?
9. Do you carve out Behavioral Health Services?
10. Do you carve out routine vision services?
11. Does a CT or MRI require Authorization if ordered by a Specialist and not a PCP?
13. Does a member have to choose a Primary Physician?
14. For members who choose a Primary Physician, why is it not on the card?
15. 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
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?
No, effective April, 1st 2010 behavioral health providers now have the ability to contract directly with our health plan. If you would like to sign a direct contract or have questions regarding your participation status with Windsor Health Plan, please contact our Provider Help Desk 866-270-5223 or by email providers@windsorextra.com.
Do you carve out routine vision services?
Yes, to EyeMed. Their phone number is 866-339-3633.
Their claim address is:
EyeMed Vision Care
P.O. Box 8504
Mason, OH 45040-7111
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.
What is the Windsor Credentialing Policy?
Windsor Health Plan, Inc. uses a credentialing process to provide members with a selection of physicians and other healthcare professionals who have demonstrated backgrounds consistent with the delivery of high quality, cost-effective health care. We have established credentialing criteria using guidance from the National Committee for Quality Assurance (NCQA) and the Centers for Medicare and Medicaid (CMS) for network participation that is used to evaluate a provider’s credentials. The credentialing criteria serves as the foundation for determining a provider’s eligibility and continued eligibility in all Windsor Health Plan, Inc. networks. Providers are expected to remain in compliance with credentialing criteria at all times.
