NaphCare is a correctional-based healthcare company that provides medical services for jails, prisons, and halfway houses across the country. We process and pay claims for community medical services rendered to our patients who are in the custody of our correctional partners.

The Provider Portal is an inclusive HIPAA-secure website where claim status and explanation of payments can be found.

Each registered user must complete a provider portal user form. A valid user-specific email address, phone number, and authorized signature must be provided. The group Tax ID number and any/all applicable NPI numbers are required to view claim status.

If you are treating an inmate from one of our correctional partners, there will be an authorization on file showing NaphCare as the responsible party. The patient will arrive with the authorization form for all non-emergent care. If you need to verify an authorization or eligibility, please reach out to us and provide all patient and appointment information, including the correctional entity, city, and state.

Please submit claims to us electronically via EDI 58182 on proper CMS-approved forms (1500/UB04). CCI edits will be followed.

We offer direct deposit and encourage all providers to enroll. ACH payments result in faster payment and avoid any lost checks or reissue delays. Please complete the direct deposit form on the Provider Portal.

EOPs can be viewed in the Provider Portal or emailed securely to approved users who are on direct deposit. Denial EOPs are issued weekly to aid in the submission of correct claims. EOPs are not sent via USPS.

Once you locate the claim in the Provider Portal, you can view the current status of that claim. The claim number includes the date when the claim was received. If a claim is showing as received/processing, it is on file and processing with no further details. If a claim has processed, it will show as either Pending Check or ACH Issuance, which means it is approved to pay. If it is showing as Pending Denial, the claim is going to deny. Once the claim moves to a Paid or Denied status, you can then click on the claim number in blue to see the details.

Claims can be appealed by logging into the Provider Portal and reviewing the claim that you feel is either underpaid or denied incorrectly. On the claim, hit dispute, and it will pre-populate information and give you room to free text and to attach supporting documentation. An appeals ticket is created, and your dispute is routed to the appeals department for an independent review.

While an inmate ID is not required, we do recommend using the ID number in place of the social security number to ensure an accurate patient match. The inmate ID is on the authorization form that accompanies the patient.

You will be prompted to reset your password every 90 days. The Reset Password option is available on the Provider Portal to change your password at any time; please be sure to notate the ticket number for any password resets. Users may not share usernames or passwords. If you have forgotten your password, please email provider.portal@naphcare.com.

Claims are paid according to the contract rates on file for each vendor group. Timely filing and payment terms are set by the vendor’s contract with NaphCare. A current W9 must be on file for payments to be released. Patients are not responsible for a co-pay or deductible and should not be balanced billed. Please contact provider.relations@naphcare.com to become a participating provider.