Electronic Claims

Vendor information

Providence Health Plan contracts with numerous vendors to assist in filing claims electronically. Below is a list of our vendors along with pertinent information that can help you decide which vendor is the best fit for your office’s needs. Providence Health Plan offers electronic claims payment at no charge to our providers. Claims sent electronically are paid on average of 10 business days.

For assistance, contact:

Deb Wallenstein, EDI business analyst
Information Services
503-574-7450
debra.wallenstein@providence.org

Susan Naanes, EDI database analyst
Information Services
503-574-7441
susan.naanes@providence.org

Vendor Name Contact Information Transaction Types Plan ID/Payer ID Numbers Sub Contracted though
Availity Contact your Availity representative, for electronic claims information 800-282-4548 Professional claims Health Plans = PHP01
PPO = PHP00
Capario
(MedAvant)
*Capario/MedAvant Provider.Enrollment@MedAvantHealth.com Or 800-792-5256 Ext. 812 Professional claims
835 Remittance
Advice (ERA)
Health Plans = PHP01
PPO = PHP00
CareVu Contact your CareVu representative for electronic claims information
www.carevu.com or 888-744-6638
Professional claims Health Plans = PHP01
PPO = PHP00
Capario
(MedAvant)
eClaims Contact your eClaims EDI representative for electronic claims information 626-549-4517 www.eClaims.com Professional claims Health Plans = PHP01
PPO = PHP00
Capario
(MedAvant)
EDI Healthcare Contact EDI Healthcare for electronic claim information. www.edihealthcare.com or 866-337-4014 Professional claims Health Plans = PHP01
PPO = not set up
Capario
(MedAvant)
*Emdeon
Envoy/WebMD/Sage
www.emdeon.com/enrollment
866-369-8805
Professional & Intuitional claims 835 Electronic Remittance Advice (ERA) Health Plans = SX133
PPO = SX187
ENS Contact your ENS representative for electronic claims information.
www.enshealth.com or 800-341-6141
Professional claims Health Plans = PHP01
PPO = PHP00
Capario
(MedAvant)
ET&T www.ettch.com
480-325-0901
Professional claims Health Plans = SX133
PPO = SX187
Emdeon
*FCHN Professional & Institutional claims Washington providers =
91131 (not Vancouver)
Gateway EDI Contact your Gateway EDI representative for electronic claims information
www.gatewayedi.com or 800-556-2231
Professional claims Health Plans = PHP01
PPO = PHP00
Capario
(MedAvant)
GE Healthcare/Centricity/IDX Contact your GE Healthcare representative for electronic claims information
www.gehealthcare.com
Professional claims Health Plans = SX133
PPO = not set up
Emdeon
GHN Contact GHN for electronic claim information.
214-696-5717 or www.ghnonline.com
Professional claims Health Plans = SX133
PPO = SX187
Health Plans = PHP01
PPO = PHP00
Emdeon and Capario
(MedAvant)
Health-e-Web Contact Health-e-Web EDI representative for electronic claims information
877-565-5457 www.Health-e-Web.net
Professional claims Health Plans = PHP01 Capario
(MedAvant)
Health Fusion Professional claims Health Plans = PHP01
PPO = PHP00
Capario
(MedAvant)
*MCPS - Medical Claims Processing Solutions MCPS 1-800-879-7534 mcp@mcps-inc.com
Steve Singer (at AMB) Steves@ambpro.com 503-291-7134 ext. 12
Professional claims Institutional claims 835 Remittance Advice (ERA) Health Plans = ORD02
PPO = ORD14
Misys and PayerPath Contact Misys for electronic claim information. 866-647-9787 www.misyshealthcare.com Professional claims Health Plans = 000735
PPO = 001478
RelayHealth and Capario (MedAvant)
Navicure Contact Navicure for Providence payer ids www.navicure.com or 770-342-0200 Professional claims Health Plans = P1238
PPO = 91186
Capario
(MedAvant)
*Office Ally 866-575-4120
info@officeally.com
Professional claims 835 Remittance Advice (ERA) Health Plans = PHP01
PPO = PHP00
*Payer Connection products@payerconnections.com
or 503-419-6208
Professional claims 835 Remittance Advice (ERA) Health Plans = PHP01
PPO = PPOOR
Payer Path/Allscripts See Misys
Premera Blue Cross www.premera.com for detailed information Professional claims Health Plans = 00430
RealMed www.RealMed.com
877-732-5633
Professional claims Health Plans = SX133
PPO = SX187
Health Plans = PHP01
PPO = PHP00
Emdeon and Capario (MedAvant)
*RelayHealth/McKesson Contact your RelayHealth representative for electronic claims information or call 800-782-1334
www.RelayHealth.com
Professional and Institutional claims. 835 Remittance Advice (ERA). Health Plans
Professional = 4498
Institutional = 1540
PPO
Professional = 2403
Institutional = 1915
*RelayHealth/National Data Corp (NDC) Contact your RelayHealth representative for electronic claims information or call 408-985-1777 Professional and Institutional claims 835 Remittance Advice (ERA) Health Plans
Professional = 4498
Institutional = 1540
PPO
Professional = 2403
Institutional = 1915
*RelayHealth/Per Se' Technologies www.MHS@McKesson.com 800-782-1334 Professional claims only.
835 Remittance Advice (ERA)
Health Plans = 1999000
PPO = 1999001
*SSI Group www.TheSSIGroup.com 800-880-3032 Professional and Institutional claims.
835 Remittance Advice (ERA)
Contact vendor for Payer ID's.
WebMD/Envoy/Emdeon Sage www.emdeon.com/enrollment need to fill out an enrollment form.
866-369-8805
Professional claims 835 Electronic Remittance (ERA) Health Plans = SX133
PPO = SX187
ZirMed Contact ZirMed for electronic claim information. 877-494-7633 or info@zirmed.com Professional and institutional claims Health Plans = CPID 4498
PPO = CPID 2403
RelayHealth

*Indicates a direct connection with Providence Health Plan and clearinghouse.

If your clearinghouse is not listed, contact your vendor to check if they have a connection to one of the listed clearinghouses. You also can conduct a search of your clearinghouse online by typing the name of your clearinghouse along with “payer list” into your preferred search engine (e.g., Google, Yahoo, etc.)

835 Electronic Remittance Advice (ERA)

If you are interested in receiving the 835 Electronic Remittance Advice, or ERA, from Providence, please contact your clearinghouse. Your clearinghouse will set up the ERA for you. Once ready, the clearinghouse will contact Deb Wallenstein or Susan Naanes to start sending your data. The ERA will be available each Monday and Wednesday from your clearinghouse. Along with the ERA, you will continue to receive paper EOPs until you notify Providence to stop sending paper.

Questions?

For assistance, contact:

Deb Wallenstein, EDI business analyst
Information Services
503-574-7450
debra.wallenstein@providence.org

Susan Naanes, EDI database analyst
Information Services
503-574-7441
susan.naanes@providence.org

**Providence Health Plan does not pay for any costs associated with submission of paper claims.