CommuniCare Advantage
CommuniCare Advantage is a Medicare Advantage plan operating in Indiana, Maryland, and Ohio. For an ASC, what matters isn't the logo. It's how CommuniCare Advantage pays: where it runs rich, where it runs thin, and how its reimbursement compares with peer plans for the same procedures.
Pilot Analysis
Get the complete CommuniCare Advantage analysis
Tell us where to send it. Our team will prepare an analysis of CommuniCare Advantage covering rates by code, market position, and underpaid areas, and email it to you within 5-10 business days. Need it faster? Book a demo.
What Insights reveals
How CommuniCare Advantage pays
See how CommuniCare Advantage reimburses across procedures and markets, benchmarked against the peer plans competing for the same cases. Not a raw rate sheet, a read on where it sits.
Geographic footprint
CommuniCare Advantage's presence spans Indiana, Maryland, and Ohio. See where it concentrates and how that shapes the markets you compete in.
Peer position
Put your own position next to the benchmark for CommuniCare Advantage and bring the gap to your next contract conversation.
Specialty mix
Understand which procedures and specialties drive CommuniCare Advantage's volume, so you know where a rate change moves the needle.
Whether you're an ASC benchmarking a contract or a provider team looking CommuniCare Advantage up, DataLily AI maps how it reimburses across procedures and markets, and where your own rates sit against the peer benchmark.
Reference
Working with CommuniCare Advantage
- Payer ID
- 34525 is the EDI identifier used to route electronic eligibility checks (270/271), claim-status inquiries (276/277), and claims to CommuniCare Advantage through a clearinghouse.
- Eligibility verification
- Coverage and benefits for CommuniCare Advantage members are verified before the date of service, through a clearinghouse using payer ID 34525or through the payer's provider portal.
- Prior authorization
- Requirements are set per plan and per procedure. Confirm whether an authorization is required with CommuniCare Advantage directly before the date of service.
Book a demo: pick a time
A 15-minute walkthrough of CommuniCare Advantage the way it pays.
- What is CommuniCare Advantage's payer ID?
- CommuniCare Advantage's electronic payer ID is 34525. ASC billing teams use it to route eligibility checks (270/271), claim-status inquiries (276/277), and electronic claims to CommuniCare Advantage through a clearinghouse.
- How do ASCs verify eligibility for CommuniCare Advantage members?
- Eligibility and benefits for CommuniCare Advantage members are verified before the date of service, either electronically through a clearinghouse (a 270/271 transaction using payer ID 34525) or through the payer's provider portal.
- Does CommuniCare Advantage require prior authorization for ASC procedures?
- Prior-authorization requirements for CommuniCare Advantage are set per plan and per procedure. Confirm whether an authorization is required with CommuniCare Advantage directly before the date of service.
- What type of payer is CommuniCare Advantage?
- CommuniCare Advantage is a Medicare Advantage plan operating in Indiana, Maryland, and Ohio.
- How does CommuniCare Advantage compare with other payers for ASC procedures?
- Ask Rose and you get a plain-language read on where CommuniCare Advantage pays above or below peer plans for your top procedures, charted, and ending in a recommendation you can take into a contract conversation.
- Is CommuniCare Advantage paying my ASC below market?
- Put your own CommuniCare Advantage contract next to the peer benchmark in DataLily AI and you'll see the gap by procedure and market, the fastest way to know whether you're leaving money on the table.