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Did You Know?

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One of our top questions received in Provider Services is how to check a claim status. The Provider Portal is yours to use 24 hours a day, seven days a week to check claim status.

  1. Enter the portal at https://www.buckeyehealthplan.com/providers.html
  2. To check the status of a claim
    a. Access Claims
    b. The search date will default to the last 30 days
    c. You can narrow down your search by using the search feature
    d. Click the claim number to view claim details
  3. To view or download you explanation of payment
    a. Access Claims
    b. You can use the filter to narrow by date of check or use the check number
    c. Click the check date to open the EOP. The PDF will open in a separate window where you can save or print.

If you receive a claim denial with one of the denial codes below you can request a claims reconsideration within, 180 days of the denial, one of two ways:

  1. Request the reconsideration using the Secure Provider Portal.  You can upload the medical records to the portal.
  2. By completing a provider adjustment form, located on our Forms Page in the Medicaid/General Forms section of our website, to the applicable address listed below. 

Note: Your request must include medical records.

Denial Codes

Medicaid

Medicare

ys       aJ      
2L       ya      
CB       ys      
HB       yt      
hf       yw      
HG       hc      
HL       hf      
Hn       HG      
HP       HL      
HS       hp      
HT       hS      
HU       HT      
Nk       b2      
Nl       Nk      
UE       Nl      
UJ       x7      
AN       x8      
xE       y0      
xL       y1      
xP       ye      
xM       YO      
  z3      
  Xl     
For Medicaid:
Buckeye Health Plan
P.O. Box 6200
Farmington, MO 63640
For Medicare:
Buckeye Health Plan
Advantage P.O. Box 3060
Farmington, MO 63640-3822
   

Google Chrome – Click the three dots in the right-hand corner and scroll to More Tools – Clear Browsing Data – Advanced – Time Range - All Time and click top 4 boxes and Clear Data.  Close Google Chrome and reopen.  Go to https://www.buckeyehealthplan.com/providers.html. (this can be saved as a favorite) and click on Portal Login mid-way down the page.

Microsoft EDGE – Click the three dots in the right-hand corner and scroll to History – Click on the three dots in the right-hand corner – Clear Browsing Data – Time Range – All Time and click on the top 4 boxes and Clear Now.  Close Edge and reopen.  Go to https://www.buckeyehealthplan.com/providers.html. (this can be saved as a favorite) and click on Portal Login mid-way down the page.

Foxfire – Click on the Library menu – Click on History – Clear Recent History – Time Range – All Time – Click on Browsing & Download History, Form & Search History, Cookies and Cache – Clear Now.  Close Foxfire and reopen.  Go to https://www.buckeyehealthplan.com/providers.html. (this can be saved as a favorite) and click on Portal Login mid-way down the page.

Internet Explorer – Click on Tools – Click on History – Internet Options – Browsing History – Delete Browsing History – Click top 4 boxes and Delete.  Close Internet Explorer and reopen.  Go to https://www.buckeyehealthplan.com/providers.html. (this can be saved as a favorite) and click on Portal Login mid-way down the page.

EntryKeyId recovery email may be in the Junk or Spam file and will have to be moved to the Inbox to access the recovery link.  If the email was not being received, have provider verify with their IT department that no-reply@entrykeyid.com is unblocked.

  • Step 1: From the Provider Home Page (PHP), select Prior Authorizations, then select Pre-Auth Check.
  • Step 2: Select the applicable plan: Ambetter, Medicaid, Medicare or MyCare to open the correct tool.
  • Step 3: Be sure to read the Disclaimer in full.
  •             Note: All out-of-network providers require a prior puthorization.
  • Step 4:  Answer the series of questions.
    • Please note:
      •  If the answer is ‘yes’ to the first question (Are services being performed in the….), then NO authorization is required.
      • If the answer is ‘no’ you will continue on to answer the rest of the questions.
        • If at any time on the remaining questions the answer is ‘Yes’ it will notify you that a Prior Authorization is required and ask you to Log In to submit it.
        • If the answer is ‘no’ on all remaining questions, the tool will ask for the code you are checking.  NOTE: Leaving any empty spaces after the 5 digit code will generate an error.
          • When entered properly it will indicate if an authorization is necessary:
            •  Authorization is not needed – green ‘no’.
            • Authorization is required – red ‘yes’. You will need to log in and submit the prior authorization.

Special note for the MyCare Tool

  • You may see other responses after submitting the code:
    • C-Conditional: Means there are certain conditions when PA is required, i.e., the allowable therapy visits have been used.
      • You will need to submit an authorization request for final determination by our UM Department.
    • Y-Yes: Pre-authorization required for all providers. Please enter authorization in Medicaid.
    • ·Green ‘No:’ The procedure code is not a covered benefit under the Buckeye Community Health Plan.
    • ·Orange “Maybe”:  This means there are other outlying indicators not able to be answered with a simple “yes” “no” and need final determination by our UM Department. An authorization submission is suggested.