Your questions are important to us. We want to ensure you have the information you need to provide care to our participants. These are the answers to some of the most common questions we get from providers.
If your question isn’t answered here, please call our Provider Services department at 702-892-7313.
We update our participants’ eligibility in 2-month increments. Please schedule the surgery, and then re-check the patient’s eligibility closer to the surgery date.
Your patients can get over 300 generic prescriptions for no copay at our Culinary Pharmacies.
When possible, please prescribe generic medications to help your patients get the medicine they need at the most affordable price.
If your patients are 35 or older and have not had a mammogram in the past 11 months, they’re eligible for a mammogram. Patients can get their screening mammogram through an in-network free-standing radiology provider for no copay.
Make sure you provide screenings on time to ensure claims are paid correctly.
The Culinary Health Fund offers extended eligibility benefits for patients who become temporarily or permanently totally disabled. This allows your patients who are disabled to keep their benefits for up to 24 months.
An Extended Eligibility applicationDownload PDF must be completed by the patient, their employer and you (if you’re the doctor disabling the patient). All three must complete this application correctly to avoid any delays in extending current eligibility.
Per our contract, do not charge patients to fill out extended eligibility forms.
In order for the patient to qualify:
The Culinary Health Fund offers Loss of Time benefits. This weekly benefit is for patients who become disabled while employed and are prevented by such disability from performing their regular job duties. Documentation of disability is required from the physician and employer before benefits are paid.
Per our contract, do not charge patients to fill out loss of time forms.
Claims are usually given pending status while we wait for more information from either you or your patient.
We may need more information from your patient if:
We may need more information from you if it looks like the diagnosis/information on the claim appears to show an injury that was work-related, caused by a motor vehicle accident, or caused by a third party.
In these cases, in order not to delay processing of the claim, it is important to send us any relevant information regarding the claim — such as the chart notes or injury forms.
Once all of the needed information is provided, the claim will be processed. If the information is not received within 45 days, the claim will be denied, but can be reopened when all of the information is received.
You can find out if a claim was received by:
The Culinary Health Fund coordinates benefits. If we are secondary, and the primary payor has already paid more than our allowable amount, we consider the claim paid, since you have already been paid at least what you would have received from the Culinary Health Fund if we were the only payor. If you are paid less than our allowable amount by the primary payor, we will pay the patient’s liability, up to our allowable.
Yes, you may bill the patient for the copays, deductibles, and co-insurance when the Culinary Health Fund doesn’t pay anything as secondary.
Any work-related claims must be denied by Workers Compensation before the Culinary Health Fund will consider payment. If the claim was denied by Workers Compensation, all we need is a copy of the denial letter for the claim to be considered for payment. If the patient never reported the injury to their employer and it is work related, the claim will be denied by the Culinary Health Fund.