Provider Resources

Good news! Referrals are no longer required for Decent's plans as of January 1, 2022. You do not need to submit a referral to us for any specialist care needed for our members. However, members must still see their designated primary care provider first before seeing any specialists so that you can help coordinate their care.

Review our Reimbursement Policies for more information on the following topics:

• Bundled Services
• Drug Testing
• Non-Reimbursable Services
• Transfer
• Evaluation and Management Service
• Radiology
• Physician-Administered Drugs
• Durable Medical Equipment
• Intraoperative Neuromonitoring
• In-Office Laboratory Testing & Procedures
• Obstetrical Care Bundling
• Assistant Surgeon
• Co-Surgeons / Team Surgeons
• Anesthesia
• Hospital Based Clinics
• Bilateral Procedures
• Multiple Procedures
• Unlisted and Unspecified Procedures
• Medically Unlikely, Mutually Exclusive, and Component Procedures
• Services Incidental to Admission
• Observation Stays
• Surgical Supplies
• Emergent Admissions
• Readmissions
• Mid-level Providers
• Never Events
• Surgical Techniques
• Add-on Codes
• Incident-to services

Review Decent’s Provider Manual  to learn more about:

• Pre-authorization requirements
• Claim processing
• Appeals
• And other important topics

Electronic Submission

Decent highly recommends that providers submit claims electronically via your billing software and clearinghouse of choice using Decent’s Electronic Payer ID: DECENT

If you are having any issues submitting claims to Decent electronically, please contact your billing vendor to ensure they have Decent’s Payer ID in their system. Our clearinghouse is Healthcare IP.

Paper Claim Submission

If a claim cannot be submitted electronically, a paper UB-04 or CMS-1500 should be submitted to:

Decent
P.O. Box 4366
Seattle, WA 98194-0366

           Type (Ansi v5010)      Description                  270/271      Eligibility Request and Response              276/277      Claim Status Inquiry and Response              835      Remittance Advice              837      Health Care Claim      

We are excited that you want to join Decent’s network. We are always looking to grow our network in Texas, and will expand to other states soon. Please reach out if you’re interested in joining us.

Here is how to join our network:

1. Request a provider agreement at support@decent.com.
2. Once you receive the contracting packet

• Review and sign the Contract
• Complete the enclosed W-9 and Profile documents
• Fill out the 835 Enrollment form to receive Electronic Remittance Advice
• Fill out the EFT form to get reimbursed faster
• If you are an individual provider or provider group, please complete the enclosed Group information for billing purposes.

3. You may submit your completed documents through any of the following methods:

• Email to: support@decent.com
• Mail to: Decent, P.O. Box 4366, Seattle, WA 98194-0366(Please retain a copy for your records)

4. Remember that we’re here to help - if you ever have any questions, feel free to either reach us by chat on our website,  by email at support@decent.com,  or by phone at:

866-HEART-US (866-432-7887)