Support - Detego Health (2024)

We are a Third-Party Administrator for small to mid-size companies. We are not an insurance company. We coordinate all the services needed to administer self-insured and level funded plans for employers.

Keep in mind that your benefits are not like traditional insurance. Staying within the defined benefit network (Plan’s Network, MyLiveDoc, Green Imaging, etc.) and utilizing the established protocols for non-emergency medical needs will ensure cost savings.

Please call or email our Care Guides team prior to accessing care outside of these defined protocols in order to avoid balance billing and/or denial of claims.

Click your Network Provider Search link below.

First Health Network

PHCS

HealthSmart

Emergency Room Visits: In an emergency, you may visit ANY ER you can access. Just give us a call the next day to inform us.
Imaging Services (MRI, CT Scans, PET Scan, or Xray): These services must be pre-certified.
Labs and Blood Work: Your Plan’s Network is available for blood work.

For any and all questions on your plan: call our Care Guides at (866) 815-6001.

No! Detego Health plans do not require you to select a primary care physician or obtain a referral to see a specialist. However, an ongoing relationship with a primary care physician can help you manage your health and address any concerns you have early on. You can use the Plan’s Network Provider Finder from your computer or mobile phone Web browser to search for primary care physicians for you and your covered family members in specialties such as internal medicine, family practice and pediatrics.

Click your Network Provider Search link below.

First Health Network

PHCS

HealthSmart

Provider directories are not printed as they are updated frequently. Refer to your insurance card to find your Plan’s Network website and phone number to reach.

Click on your Network Provider Search link below to view the most current list of providers online.

First Health Network

PHCS

HealthSmart

You can find Summary of Benefits and Coverage online at DetegoHealth.com/resources/ under the section titled “Member Resource Documents”.

You can also call our Care Guides at (866) 815-6001.

The Detego Health ID cards display only the subscriber (employee) name and Employee Coverage Tier. The cards are to be used for all eligible family members even though their names are not printed on the card. If you need an additional card, you can request one by contacting our Care Guides at (866) 815-6001.

Providers- Mail claims to: Detego Health, PO Box 211609, Eagan, MN 55121 OR Electronically: Payer EDI # 62599

  • Any claim $10,000 or more, Detego Health ATTN NaviClaim, 759 N 114th St, #300, Omaha, NE 68154
    • In-Patient/Out-Patient Stay Include: Itemized Statement and Medical Records


Individuals- Be sure to show your new ID card to each provider you see.

  • If you receive a Superbill, please mail to: Detego Health, PO Box 211609, Eagan, MN 55121
  • If you self-pay, please fill out a reimbursem*nt form and mail to: Detego Health ATTN NaviClaim, 759 N 114th St, #300, Omaha, NE 68154 or email to info@NaviClaim.com
    • Please follow the instructions that are attached to the Reimbursem*nt Form.
    • Click here to download form

You can reach our Care Guides Monday through Friday, from 7AM to 5PM Central Standard Time. Our Care Guides are available to explain your benefits, answer questions about claims or assist with any other need. Please call (866) 815-6001 or visit us online at www.detegohealth.com

Yes! Once you receive your welcome packet you can email us directly at memberservices@detegohealth.com

Any medical provider or facility charges incurred outside of the U.S. must be paid by the member and a reimbursem*nt request form completed including an itemized receipt of services and proof of payment. The completed reimbursem*nt form with required information should be mailed to:
Detego Health
759 N. 114th Street
Omaha, NE 68154

If medical services are rendered outside of your home city or state, the claim will be paid according to the network status. If the provider or facility is out of network, the claim will be paid accordingly.

There are a couple options to have a representative speak on your behalf.

1. Single Use:
You may call in with your designated representative on the line and notify the Detego Health staff member that you would like the representative to speak on your behalf. This will allow the staff member to discuss your information with your representative for that call only.

2. One Year Increments:
To set up a long-term representative to speak with Detego Health on your behalf, complete the Release of Information form (ROI) that you can download here or request this form from our customer service department. Once completed and submitted to Detego Health, this form will be valid for 1 year from the date of signature.

Please contact ScriptAide, our pharmaceutical access coordination program that can assist you in getting medications at a lower cost or even for free. ScriptAide can be reached via phone at 866-837-1515 or via email at info@scriptaide.com

Please complete a formulary exception request form. This form can be found downloaded here. If you would like the form to be emailed to you, please contact our Care Guides at 866-815-6001.

Completed forms should be submitted via fax to 855-613-4102 or emailed to Info@GuideCM.com.

Click here to find out more about Formulary Exception Requests

All of the Detego Health plans are an “open access” plan. You can be treated at any Emergency Room/Hospital that you choose. This ensures that you are always able to access emergency services when and where needed. If your plan has a designated network of providers/facilities, being seen at an out-of-network facility will result in claims being paid at a lower rate than in-network providers/facilities.

Precertification requests are received directly from providers and are reviewed for medical necessity. An approval or denial notification is sent to the provider and member.

Precertification appeals are reviewed in the same manner. Peer to Peer conversations is scheduled as requested.

For questions regarding precertification, appeals or peer to peers, contact our GuideCM team at 1-866-837-1714, email at info@guidecm.com or via our website at www.GuideCM.com.

Please visit the network website listed on your insurance card. There you will be able to search for providers available in your area. You can also contact a Member Advocate from our NaviClaim team at 1-866-837-1436 if you need assistance. Click your Network Provider Search link below.

First Health Network

PHCS

HealthSmart

Click here to download the Coordination of Benefits form. Please fill out the form and send back to Detego Health via fax 1-866-837-1436 or email to info@naviclaim.com.

Support - Detego Health (2024)
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