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NextGen MyCare for Non-Contracted Providers

How to work with Buckeye Health Plan as a non-contract provider.

We are pleased to provide the following information for Community Providers, FQHCs/RHCs, qualified family planning providers, hospitals and as applicable, certified nurse midwives, certified nurse practitioners and free-standing birth centers. If you have questions, please contact Provider Services at: 866.296.8731.

Provider Home Page

To ensure we make our providers aware of the latest updates and key information, how to contact us and access to our secure provider portal, we maintain our Provider Home Page. On this continuously updated page, you’ll also find the website main menu to take you wherever you want to go. Be sure to bookmark this page as your entry point to the Buckeye website and portal.

Provider Resources

For a wide variety of everyday or special needs you can access our Provider Resources section of the website for a list of various information you’ll find useful. Among the many items are our Clinical and Payment Policies, Appeals Information, Forms and our Provider Manual.

Please note, members coming on plan from another MCO have 90-days continuity of care to continue services with their non-contracted providers and 365-days when coming on plan from other waiver types.  Providers can Join Our Network or assist members in transitioning to a Contracted Provider.

Physicians, other licensed health professionals, facilities, and ancillary providers contract directly with Buckeye for payment of covered services. If you are an out-of-network provider seeking payment for claims for emergency, post-stabilization, and any other services authorized by Buckeye, please review these guidelines below.

It is important that providers ensure Buckeye has accurate billing information on file.

Please provide accurate information as follows:

  • Provider name (as noted on his/her current W-9 form)
  • Physical location address
  • Billing name and address (if different)
  • Tax Identification Number

Claims eligible for payment must meet the following requirements:

  • The member is effective on the date of service;
  • The service provided is a covered benefit under the member’s contract on the date of service; and
  • Referral and prior authorization processes were followed, unless the service was an emergency service.
  • For detailed information, please refer to the Provider Manual or, call Buckeye’s Provider Services Department at 866-296-8731. 
  • Payment for service is contingent upon the service being provided to treat an emergency, or the service was in compliance with referral and prior authorization policies and procedures, as well as the billing guidelines.
  • For Buckeye members, all claims and encounters should be submitted to the general claim department address listed in our Provider Manual, unless it’s a specialty service as noted:

Envolve Dental
844.464.5634
Fax:844.847.9807

Dental Claims Submission
PO Box 22687
Tampa, FL 33622-2687
844.464.5634

Envolve Vision
Provider Services 866.442.6173
Customer Service 800.840.7032

Vision Claims Submission
Envolve Vision Attn: Claims
PO Box 7548
Rocky Mount, NC 27804
866.442.6173