- Create Provider Directory
- Document Library
- Frequently Asked Questions
- Who Is My Provider Representative
- Claims Information
- HIPAA 5010 and ICD10
- Provider Inquiries
- ELECTRONIC SOLUTIONS
- Secure Provider Portal
- EDI Documentation
- User Support & Training
- NETWORK PARTICIPATION
- Provider Nomination
- Credentialing Criteria
We take great pride in our network of physicians and related professionals who serve our members with the highest level of quality care and service. We are absolutely committed to making sure our providers receive the best possible and latest information, technology and tools available to ensure their success and their ability to provide for clients.
At Coventry, we focus on operational excellence, constantly striving to eliminate redundancy and streamline processes for the benefit and value of all of our partners. Learn why providers have chosen to join us as their partners in managed health care.
- Easy and simple experience
- Operational excellence
- Financial discipline
- Empowering environment
National Participating Provider Precertification List (NPL) - always access document for current precertification requirements.
DirectProvider.com - Your Online Solution
Coventry’s free online provider portal, directprovider.com, allows you to access critical information wherever and whenever you need it. This innovative and secure tool is available with all Coventry Health Care plans and provides direct connection to data management for up-to-date information including: A superior online tool, directprovider.com is designed and maintained to the highest standards, promising accurate information and faster access to the information you need, when you need it.
The prior-authorization process is also quick and easy with directprovider.com. Providers can submit, look-up, or edit authorizations online, at their convenience. And, with our exclusive Adjustment Reconsideration function, providers have the opportunity to request a review/reconsideration of an authorization and submit the documentation online in support of that request.
Coventry prides itself on the EDI tools it has available for its providers and with directprovider.com, Coventry can boast one of the most multi-functional payer websites available to its providers in the health care industry.
Webcast training is offered quarterly on our DirectProvider.com application and its functionalities. Please review the training opportunities via the links offered below and follow the registration instructions contained within each PDF.
> DirectProvider.com - All Functionalities
A superior online tool, directprovider.com is designed and maintained to the highest standards, promising accurate information and faster access to the information you need, when you need it.It allows providers the ability to verify Eligibility benefit information before services are rendered. The Claim Inquiry section provides the ability to view claims by status (Paid, Pended, Denied, Rejected, etc.), and search for claims by member, claim number, or date range, for any 30-day period, with up to 3 years worth of claims history available. Claims disposition codes are easy to understand and each claim clearly displays member responsibility. You can see pre-existing conditions, authorization numbers, and line level detail for each claim, as well as, the date we received the claim and how and when it was transmitted through our system. The Online Claims Adjustment Reconsideration function evens allows a provider the opportunity to request a review/reconsideration of a claim that they feel did not properly adjudicate, even at the claim line level, and submit documentation online in support of that request.
For provider support questions pertaining to the Coventry Health Care, Inc. business, please refer to the following contact and support information available below:
Our physicians and ancillary health care providers are key to the quality plans and service we promise clients. At Coventry, we believe in putting exceptional people in an empowering environment where individuals are accountable for their efforts. As a team we strive to support each other and exceed expectations.
Our network includes more than 4,800 hospitals, 555,000 professional providers and 68,000 pharmacies. Our ever-expanding network speaks to our client satisfaction. We are proud of our track record of success and aggressive growth supported by exceptional service.
Secure Provider Portal
Coventry’s free online provider portal, directprovider.com, allows you to access critical information wherever and whenever you need it. This innovative and secure tool is available with all Coventry Health Care plans and provides direct connection to data management for up-to-date information.
Manage all your Coventry health plan needs at our secure, one-stop, multi-functional provider portal.