MEMBERS

To request a new ID card please call Customer Service at 866-607-0117.  You can also view or email a copy of your ID card through the Vista4me app that is available on both iPhone and Android devices. It usually takes 7-10 business days for your new card to be mailed.

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To change your PCP  you can download the Vista4me app or call Customer Service at 866-607-0117. This change will take effective the first of the month following your request.

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To change your physical or email address please call Customer Service at 866-607-0117.

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You may terminate coverage voluntarily by giving written notice to the plan. The effective date of coverage termination will be the last date of the month after Your request was received unless You request a later date. To terminate your plan or dependent, please send an email to enrollment@vista360health.com. Be sure to include each person you are terminating including their member ID and the date of the termination.

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To add a dependent due to a qualifying event (i.e. birth or marriage) please send an email to enrollment@vista360health.com to obtain the appropriate form.

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To check the status of a claim please contact Customer Service at 866-607-0117

You can also check claim status by logging into your Member Portal or by downloading the Vista4me app. This app is available for both iPhone and Android devices.

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You can view the most up to date listing of our providers and pharmacies at https://www.vista360health.com/find-a-provider/

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To change your current payment option please email memberservices@vista360health.com. Please note that at this time we do not accept credit cards. Bank draft and check are the only options available.

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An External Review allows an independent outside review of adverse benefit decisions (denials). An adverse benefit decision means Vista360health decided against your request to authorize care or has not paid for services already performed through a Retrospective (Claims) appeal. There is a standard External Review and, for emergent and urgent cases, an expedited (faster than usual) External Review.

The External Review can be used for denials that involve: medical necessity, appropriateness, health care settings, level of care, the effectiveness of a covered benefit, whether a treatment is experimental or investigational, and any other matter that involves medical judgment.

For more information click here

PHYSICIANS

KEY CONTACT INFORMATION

  • Main: 512-614-4780
  • Main: 512-420-2777
    FAX: 512-420-2798 or
    866-272-2542
  • Main: 800-557-5403
    Fax: 512-421-4899
  • Main: 866-607-0117
  • Vista360health
    Austin, Texas 78761
    P.O. Box 15402
  • Vista360health
    Attn: Reconsideration or Refunds
    PO Box 14545
    Austin TX 78761-4545
  • Main: 866-607-0117
  • Main: 866-607-0117
  • Main: 512-614-4780
  • Main: 855-673-6504
For more information click here

SAMPLE ID CARD

HMO Health Plan #: 000000
Group #: 123456

Insured:
John Doe ID #12345678901
PCP:
Jane Doe ID #12345678902
PCP:
Baby Doe ID #12345678903
PCP:
Child Doe ID #12345678904
PCP:

vista360RXBin 610602
RxPCN NVT
RXGRP V3H

Navitus Pharmacy
Benefit Manager

Generic Drugs $10 copay
Preferred Brand Drugs $50 copay
Non-preferred Brand Drugs 50%
Specialty Drugs 50%

id card 011
For Enrollees:
866-607-0117
For Providers:
Check Eligibility:
866-607-0117
Prior Authorization and Admission Notification requirements apply:
Prior
512-420-2777
Authorization:
Notification:
800-557-5403
Medical Claims:
P. O. Box 15402 Austin, TX 78761
id card 012

For more information click here

ELIGIBILITY VERIFICATION

All participating providers are responsible for verifying an Enrollee’s eligibility at each and every visit. Providers can verify enrollee verification through one of two methods:

  • Contact Vista360health Customer Service at 866-607-0117.
  • Access current enrollee information online through the Vista360health Provider Portal.

For more information click here

ELIGIBILITY VERIFICATION

You have the option of submitting claims electronically or by mail. We encourage use of electronic claims submission methods to help you:

  • Prepare a complete and accurate claim form.
  • Receive explanations of payment and your reimbursements more quickly.
  • Save time.

Electronic Claims

Providers choosing electronic submission must use the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) compliant 837 electronic format, or a CMS-1500 and/or UB-04, or their successors.

Vista360health utilizes TriZetto as a clearinghouse. Because most clearinghouses can exchange data with one another, providers should work with their existing clearinghouse to establish EDI with Vista360health. Please contact Provider Relations if assistance is needed.

Clearinghouse Payer ID Clearinghouse Payer ID
TriZetto V360H (Professional Claims) Phone: 1-800-556-2231
www.trizettoprovider.com V360I (Institutional Claims) Email: physiciansupport@trezetto.com

Paper Claims
Paper claims can be submitted to the address on the Enrollee Identification Card noted below:

Vista360health
P.O. Box 15402
Austin, Texas 78761

ELECTRONIC PAYMENT METHODS (EFT/ERA)

Vista360health offers the ability to receive claims payments and remittance advices electronically. Both options offer benefits over paper transactions. Forms can be accessed from our Provider Portal or your Provider Relations Representative.

Electronic Funds Transfer (EFT)

Electronic Funds Transfer (EFT) is the electronic exchange of claims payments. It is safe, secure and quicker than paper check payments. EFT allows payment to be deposited electronically directly into a bank account once claims payment is released. There is no need to manually deposit checks.

Electronic Remittance Advice (ERA)

Electronic Remittance Advice (ERA) enables you to receive claims payment information electronically. ERA files are transmitted in the HIPAA mandated ASC X12 835 5010 A1 format. ERA allows providers to post claims remittance advices electronically to your billing software vendor or clearinghouse to automate manual processes.

For more information click here

CLAIMS STATUS INQUIRIES

Providers can verify the status of their submitted claim status telephonically by contacting Vista360health Claims Customer Service at 1-800-607-0117 or directly through our Provider Portal. Once claims have been received and entered into our systems, claims in the Provider Portal will reflect a status of Paid, Denied or Pending.

For more information click here

An External Review allows an independent outside review of adverse benefit decisions (denials). An adverse benefit decision means Vista360health decided against your request to authorize care or has not paid for services already performed through a Retrospective (Claims) appeal.  There is a standard External Review and, for emergent and urgent cases, an expedited (faster than usual) External Review.

The External Review can be used for denials that involve: medical necessity, appropriateness, health care settings, level of care, the effectiveness of a covered benefit, whether a treatment is experimental or investigational, and any other matter that involves medical judgment.

For more information click here