Centivo Provider Portal & Support | Eligibility, Claims
A health plan anchored around high-quality healthcare providers.
A health plan that promotes what you do best — provide excellent care
Rewards for great care. Valuable data at your fingertips. Simple, no deductible plan design for less bad debt. So you can focus on your patients, not their health plans.
Trying to locate a Centivo Network provider?
Visit the Member portal to view your ID card, search for providers, see details about your coverage and explanations of benefits and connect with Centivo Member Care.
ALIGNED INCENTIVES You’re rewarded for providing great care
Centivo’s model rewards providers for care coordination and patient outcomes and experience. And to further align incentives, we also offer opportunities for shared savings with employers.
INFORMED AND MOTIVATED PATIENTS Our value-based benefit design is built on the power of primary care
Our members build strong relationships with their Primary Care Team to get the right care from appropriate providers before small concerns become big issues.
A TRUE HEALTH PLAN PARTNER An ally in delivering patients the right care with the best possible outcomes
By partnering with Centivo, you get direct interaction with employers and better access to data. Most importantly, you have a partner in guiding patients to the right care for their needs.
YOUR COMMITMENT Centivo provider partners go above and beyond to ensure an exceptional patient experience by:
- Offering enhanced access to care such as same-day appointments and 24/7 phone access to clinical staff
- Providing team and evidence-based care, including goal-directed care plans where appropriate
- Facilitating and coordinating appropriate referrals to specialists and facilities
You’ve got questions, and we have answers
How do you select your provider partners?
We start by contracting directly with high-value health systems that align with our vision and mission by focusing on:
- Advanced primary care-centered clinical models
- Patient access/experience guarantees
- Value-based payments tied to primary care-centered management
Market-leading unit costs are a requirement of every partnership – not just a selection factor. Once a health system joins the network, compensation also includes incentives for care coordination and meaningful patient outcomes. We then supplement the network with strong, independent primary care practices and targeted high-value solutions such as our Centivo Virtual Primary Care offering.
How are out-of-network services handled? Is there a wrap network in place?
Similar to other regional and local plan offerings, Centivo’s Partnership Plan – our core self-funded health plan built on the Centivo network – typically utilizes other networks for out-of-area urgent care and emergencies, such as when employees are traveling and need to access care.
Can you integrate on-site clinics into your network?
Yes, on-site clinics can be incorporated into the Centivo Network.
How do I verify patient eligibility?
Eligibility verification is available through the Centivo provider portal. You can also reach our Provider Support team at providers@centivo.com for assistance.
Where do I submit claims?
Claims are submitted through Availity at essentials.availity.com. For questions about claims submission, contact Provider Support at providers@centivo.com.
How do I check claim status?
Claim status is available through Availity at essentials.availity.com. For additional support, contact Provider Support at providers@centivo.com.
How do I contact Centivo Provider Support?
For claims, pre-certification, and general inquiries, reach us at providers@centivo.com. For provider relations and network inquiries, contact providerrelations@centivo.com.