Paper claim processing has been significantly delayed due to the cyberattack on Change Healthcare that occurred on Feb 21, 2024. CareGuard is working diligently on alternative solutions. To avoid further delay, please do not resubmit paper claims.

Electronic submissions are being processed with a minor delay.

We strongly encourage all providers to submit your claims electronically using our payer ID 20572.

Information for Healthcare Providers

About CareGuard

CareGuard is Ametros’ professional administration service your patient has selected to manage their medical fund account. Your patient sustained a work related or liability injury, which they subsequently settled. Upon settlement, they were granted funds to pay for their future medical care related to this injury. From this point on, CareGuard should be billed for all claims related to this injury. CareGuard is not an extension of Workers’ Compensation thus the same reporting rules, authorizations, and visit limits are not applicable. The services reimbursed from the MSA must be related to the members’ covered injury and, for a Medicare Set-Aside, be services that are covered by traditional Medicare.

CareGuard Card

Contact Us

Our Provider Services line, 1-877-905-7322 option 2, is available to check member eligibility and claim status from 9 a.m. to 6 p.m. EST Monday – Friday.

You may also email questions to:


Providers are obligated to bill against the MSA and “[p]roviders should also accept payment from professional administrators holding [MSA] funds. Providers should not bill Medicare where a third party holds and administers one of these MSA funds. For more information, please see:

Submitting Claims

CareGuard accepts claims typed on a CMS-1500 or UB-04. Please do not submit handwritten forms. Paper submissions should be computer generated or typed for scanning recognition. Handwritten claims may be rejected causing a delay in payment.

We highly recommend submitting claims via our electronic payer ID, 20572. This will provide a shorter turnaround time and increased accuracy.
Claims may also be mailed to the following address:

MSA CareGuard
PO Box 981609
El Paso, TX

Please note, we are unable to accept faxed or emailed claims.

Please include the CareGuard Member ID in Box 1A of the CMS-1500 or Box 60 of the UB-04.

To receive reimbursement a provider must have an NPI that matches/is registered with an existing tax identification number. NPI requirements are federally mandated. Further information on NPI is available at

Claim Processing

Claims are typically processed within 10 business days and are paid using virtual credit cards (VCC).

The VCC will arrive in the mail and can be processed the same way you would process a patient’s credit card at the time of service. If your office does not accept credit cards, there is an option on the VCC to change your payment method to a check.

For problems processing the VCC, please call Data Dimensions at 631-648-6020 or email

Claim Refunds

If a claim refund is required please follow the steps below:

Provider initiated refunds should include:

  • Member ID, Name, and DOB
  • DOS
  • Reason for refund
  • Copy of the EOR

Response to CareGuard initiated refund request should include:

  • Copy of the letter you received
  • Check made out to Ametros Financial Corporation FBO: (Member’s Name)

Mail to:

Ametros Financial Corporation FBO: (Member’s Name)
Dept 7710
PO Box 4110
Woburn, MA 01888-4110

Prior Authorizations

Provider Authorization is NOT required for medical services but is recommended for services with a cost over $5,000. PT/OT/ST, radiology, and ESI do not require prior approval. There are no visit limits on therapies and no expiration dates for authorizations.

Requests for prior authorization may be faxed to 1-877-443-9344 or emailed to

We recommend using the CareGuard Prior Authorization form.

Download Ametros Prior Authorization Form

If you prefer using your own form, please include the following information:

  • Member’s name, DOB, and CareGuard Member ID
  • Rendering provider’s name
  • Facility name
  • Requested service with CPT codes
  • Related diagnosis
  • Estimated cost

DME items always require prior approval. Requests may be faxed to 877-443-9344 or emailed to
Please include the following information on any requests:

  • Member’s name, DOB, and CareGuard Member ID
  • Member’s address and phone number
  • Provider’s name, address, phone/fax/email
  • HCPCS, quantity, description, and price

When submitting a claim, please include the case number provided by CareGuard in Box 23, prior authorization number, of the CMS-1500 form.

Physical Therapy, Occupational Therapy, Speech Therapy

Providers are required to include either GN, GO, GP modifiers per CMS Manual


Medicare guidelines limit services provided by chiropractors to 98940, 98941, 98942 billed with an AT modifier. Chiropractors are not authorized to perform x-rays or physical therapy.

Drug Testing

Please see the MLN Notice for appropriate drug testing codes.

Behavioral Health Providers

Although CareGuard does not limit service frequency we do follow Medicare guidelines regarding covered provider types. Please see here for a list of types.

Home Health

Home health must be billed on a UB-04 form following CMS guidelines. For more information, please visit:

Covered Home Health Services

For guidance on covered home health services.

Platelet-rich Plasma Injections

PRP is only covered for patients meeting specific guidelines.

Massage Therapy

Massage therapy is only covered when rendered by a licensed physical therapist.

Medication billed on a CMS-1500 must include a J code, valid NDC, and an ICD-10 code.

Unlisted/non-specific codes require supporting documentation. Please note, claims submitted with a non-specific diagnosis may be denied or rejected.

Accepting Payment from Patients with a Medicare Set-Aside Arrangement

Medicare Learning Network (MLN)

Post-Settlement Update: CMS Provides Instructions to Providers when WCMSAs Involved