Payer Guides
Generated payer-specific reference guides for provider teams handling prior authorization, filing deadlines, and claims submission.
Aetna Health
Claims Submission
Aetna supports electronic claim submission through its provider portal ecosystem, including Availity. Official materials also reference paper claim mail-to…
Prior Authorization
Aetna directs providers to use the Availity provider portal for authorizations and related workflows, and for specialty drugs uses Novologix through Availity.…
Ambetter (Centene)
Claims Submission
Claims submission methods and payer IDs vary by state plan, but Ambetter commonly supports the Secure Provider Portal, EDI/clearinghouse submission, and paper…
Prior Authorization
Ambetter generally requires prior authorization for non-urgent services before the service is delivered, with submission available through the Secure Provider…
Timely Filing Limit
Ambetter’s timely filing limit varies by state plan. Official Ambetter quick-reference materials show examples such as 180 days from date of service for some…
Ambetter from Fidelis Care
Claims Submission
Fidelis Care/QHP claims may be submitted electronically or on paper. The unique EDI payer ID is 11315. The provider manual lists paper claim mailing addresses…
Prior Authorization
For Ambetter from Fidelis Care QHP members, prior authorization is service-specific and should be checked against the current authorization grid / lookup…
Timely Filing Limit
Ambetter from Fidelis QHP claims are generally due in 90 days. Corrected claims are due in 60 days from the remittance advice. See exceptions.
Ambetter Health of Florida,
Claims Submission
Claims may be submitted through the Secure Provider Portal, via clearinghouse/EDI, or by paper mail. The Florida quick reference guide lists EDI Payor ID…
Prior Authorization
Prior authorization is required for many services. The Florida provider materials direct providers to use the Pre-Auth Needed tool first, then submit…
Timely Filing Limit
Ambetter Health of Florida uses 180 days for initial claims and 90 days for reconsiderations or appeals, subject to plan and contract rules.
AmeriHealth Caritas
Claims Submission
Claims can be submitted electronically through clearinghouses/EDI, with AmeriHealth Caritas Next using Change Healthcare in the cited materials. Electronic…
Prior Authorization
Prior authorization requirements are plan- and service-specific. For AmeriHealth Caritas Next plans, official tools state that elective inpatient services,…
Timely Filing Limit
For the cited AmeriHealth Caritas Next claims/billing manual, original invoices must be submitted within 180 calendar days from the date services were…
AmeriHealth Caritas Florida
Claims Submission
AmeriHealth Caritas Florida encourages electronic claims submission. Official provider materials identify Change Healthcare/Optum, Availity, and PCH Global as…
Prior Authorization
Prior authorization is required for certain services and is service-specific. AmeriHealth Caritas Florida directs providers to use its prior authorization…
Timely Filing Limit
AmeriHealth Caritas Florida generally requires contracted providers to submit claims within the time frame allowed by their contract, generally 180 days from…
Anthem (Community Care Health Plan of Nevada)
Claims Submission
Anthem Nevada Medicaid provider guidance directs providers to use Availity/Anthem provider website for claim submission, claim status, and disputes. EDI is…
Prior Authorization
Prior authorization/notification is required for many services, with verification available in the Precertification Lookup Tool. Requests can be submitted…
Timely Filing Limit
For Nevada Medicaid managed care, the published reimbursement policy states the standard timely filing limit is 180 days for participating…
Antidote Health Plan of Arizona,
Claims Submission
Antidote’s public materials indicate that providers usually file claims on behalf of members. If an out-of-network provider does not submit a claim, the…
Prior Authorization
Antidote states that some services require prior authorization/preservice review. Official coverage language says in-network doctors call for authorization…
Timely Filing Limit
Official public guidance states the maximum claim filing time limit for Arizona is 1 year from the date of service. This is presented in the Transparency in…
Arizona Complete Health
Claims Submission
Arizona Complete Health supports claims submission through the secure provider portal, Availity Essentials, approved clearinghouses/EDI, and paper mailing to…
Prior Authorization
Prior authorization is required for some services, and out-of-network services generally require prior authorization except ER and family planning. Requests…
Timely Filing Limit
Timely filing varies by line of business. Official claims/payment guidance states Medicaid initial paper claim submissions are timely at 120 days effective…
Av-Med,
Claims Submission
AvMed supports electronic claims submission through clearinghouses and provides paper claim mailing addresses in the provider reference guide. The provider…
Prior Authorization
AvMed directs providers to its Authorization and Referral Tool (AART) in the provider portal as the preferred submission method. The current provider tools…
Timely Filing Limit
The provider reference guide states that claims must be submitted within 180 days from the date of service; claims outside 180 days are denied. For untimely…
Baylor Scott & White Insurance Company
Claims Submission
BSWHP accepts electronic claims through Availity and paper claims by mail. The official claims page lists payer ID 94999 for electronic submissions, accepts…
Prior Authorization
Prior authorization is required for certain services and does not guarantee payment. BSWHP uses a provider portal/GuidingCare workflow for authorizations;…
Timely Filing Limit
The official claims page states all claims must be received within 95 days of date of service, with COB claims within 95 days of the primary payer's EOB date.…
Blue Cross and Blue Shield of Arizona
Claims Submission
AZ Blue requires electronic claim submission for most providers and supports professional, institutional, and dental claims through Availity Essentials and…
Prior Authorization
Prior authorization is plan-specific. For most AZ Blue plans, requests are submitted through AZ Blue’s online standardized forms or fax forms; EviCore is used…
Timely Filing Limit
Timely filing varies substantially by line of business. For Health Choice Medicaid, initial claims are generally 6 months from date of service for both…
Blue Cross and Blue Shield of Florida dba Florida Blue
Claims Submission
Florida Blue directs providers to submit claims electronically through Availity or a clearinghouse. The provider Availity page says providers can submit…
Prior Authorization
Florida Blue routes provider prior authorization requests through Availity for many services; the provider page states that providers can request…
Timely Filing Limit
Florida Blue’s provider manual says providers must file claims within the time set forth in their participating provider agreement, and notes that current…
Blue Cross and Blue Shield of North Carolina
Claims Submission
Commercial claims can be submitted through Blue e digital forms, EDI as a trading partner or through a clearinghouse, or by mail to PO Box 35 in Durham. Blue…
Prior Authorization
BCBSNC requires prior authorization for certain behavioral health, medical services, equipment, and medications, with decisions informed by medical policies,…
Timely Filing Limit
For commercial Blue Cross NC claims, the current official provider page says to submit claims within 180 days of the date of service, and paper claims go to…
Blue Cross and Blue Shield of Tennessee
Claims Submission
BCBST supports electronic claims submission and claim status checking through Availity, with paper claims used only in limited circumstances such as technical…
Prior Authorization
Prior authorization requirements vary by line of business and service type. In the commercial provider manual, prior authorization is required before…
Timely Filing Limit
Timely filing varies by product. The commercial provider manual states BlueCross BlueShield of Tennessee’s commercial timely filing period is six months from…
Blue Cross Blue Shield of Texas
Claims Submission
BCBSTX generally directs providers to submit claims electronically. Specific electronic payer IDs and paper mailing addresses vary by line of business:…
Prior Authorization
BCBSTX says the provider is responsible for requesting prior authorization before performing a service for in-network care; most out-of-network services…
Timely Filing Limit
Timely filing varies by line of business. For BCBSTX Medicaid/CHIP, claims must be submitted within 95 days of the date of service. For Blue Choice PPO…
Bright HealthCare
Capital Health Plan,
Claims Submission
CHP encourages electronic claims submission, supports direct data entry through CHP Connect, and assigns payer ID 95112. The provider FAQ says CHP accepts…
Prior Authorization
CHP uses prior authorization/precertification for certain medical, surgical, and behavioral health services. Official provider guidance says providers should…
Timely Filing Limit
For the Florida State member handbook reviewed, Capital Health Plan requires post-service claims to be received within six months of the date the service was…
CareSource
Claims Submission
CareSource Nevada Medicaid accepts both electronic and paper claims. The preferred route is online submission through the Provider Portal; the provider manual…
Prior Authorization
CareSource Nevada Medicaid requires prior authorization for services on its list; the provider portal is the preferred submission method. Emergency care does…
Timely Filing Limit
For CareSource Nevada Medicaid, the provider manual states in-network claims must be submitted within 180 days from date of service or eligibility decision,…
Celtic Insurance Company
Celtic Insurance Company dba Ambetter
Claims Submission
Claims may be submitted electronically through the secure provider portal or through clearinghouses/EDI; paper claims can be mailed to a P.O. Box that is…
Prior Authorization
Prior authorization is required for certain services and all out-of-network services except emergency room services in at least some Celtic/Ambetter markets.…
Timely Filing Limit
Timely filing is not uniform across all Celtic/Ambetter products. Reviewed official pages show examples of 90 days, 120 days, and 180 days from date of…
Centene Venture Company Florida
Claims Submission
Florida Ambetter accepts claims through the secure provider portal, EDI/clearinghouse, and paper mail. Official materials identify Availity as the preferred…
Prior Authorization
Prior authorization is obtained through the secure provider portal when possible; phone and fax are also available. Ambetter’s Florida manual says the portal…
Timely Filing Limit
For Florida Ambetter, the official materials show a 180-calendar-day timely filing limit for initial claims from date of service. For claim payment…
CHRISTUS Health Plan
Claims Submission
CHRISTUS uses the provider portal for claim status and other self-service functions, and its policy states electronic claims must be submitted via the…
Prior Authorization
Prior authorization is required for some services, and CHRISTUS states that failure to follow prior authorization requirements may result in non-payment. The…
Timely Filing Limit
Timely filing limits vary by line of business, claim type, and sometimes submission channel. Official policy OPC23 states the receipt date is when the claim…
CIGNA Health and Life Insurance Company
Claims Submission
Cigna’s official provider guidance supports electronic claim submission and provider portal use, and states that claim acceptance in the electronic workflow…
Prior Authorization
Cigna states that prior authorization/precertification requirements vary by plan and service. Official provider guidance says providers may submit medication…
Timely Filing Limit
Cigna Health and Life guidance uses 90 days for participating claims and 180 days for out-of-network claims, with separate behavioral-health rules.
Cigna Healthcare
Claims Submission
Cigna supports electronic claims submission and also routes some claims by mail to the address on the patient’s ID card. Electronic claims can include primary…
Prior Authorization
Cigna Healthcare uses prior authorization/precertification workflows that vary by service type and line of business. Providers can submit through the Cigna…
Timely Filing Limit
Cigna guidance lists 90 days for participating claims and 180 days for patient claims, with contract, plan, COB, and state-law exceptions.
Cigna HealthCare of Arizona,
Claims Submission
Cigna’s provider guidance supports electronic claim submission through EDI vendors and the Cigna for Health Care Professionals portal. For paper claims, Cigna…
Prior Authorization
Cigna states that providers can submit prior authorization/precertification requests electronically through Cigna’s online prior authorization tool, or by…
Timely Filing Limit
Cigna Arizona guidance uses 90 days for participating claims and 180 days for out-of-network claims, with contract, law, and COB exceptions.
Cigna Healthcare of Florida,
Claims Submission
Cigna supports electronic claim submission through EDI vendors and the Cigna provider portal for many administrative tasks. Paper medical claims use UB-04 for…
Prior Authorization
For Florida medical providers, Cigna provides a Florida prior authorization form and supports electronic submission through Cigna’s online prior authorization…
Timely Filing Limit
Cigna Florida guidance uses 90 days for participating claims and 180 days for out-of-network claims. Behavioral health and contract rules can differ.
Cigna HealthCare of Texas
Claims Submission
Cigna supports electronic and portal-based provider workflows, including claims submission through EDI vendors and claim/payment functions in the CignaforHCP…
Prior Authorization
Cigna directs providers to verify prior authorization/referral needs through CignaforHCP.com or the phone number on the member ID card. For Texas medical…
Timely Filing Limit
Cigna Texas guidance uses 90 days for participating claims and 180 days for out-of-network claims. Review COB, contract, and resubmission exceptions.
CIGNA Life & Health
Claims Submission
Cigna officially encourages electronic claim submission through the provider portal/EDI. For paper claims, official guidance points providers to the address…
Prior Authorization
Cigna’s official provider pages direct providers to the precertification/preauthorization resources in the provider portal and note that requirements can vary…
Timely Filing Limit
Official behavioral-health guidance uses 180 days from service or facility discharge. Other Cigna medical claims can use plan or contract terms.
Community Care Network, Inc. (22Healthplan)
Claims Submission
Electronic claim submission is through Availity, using payer ID 22HLT. Paper claims with attachments are mailed to the plan’s claims department in Pembroke…
Prior Authorization
Prior authorization is required for services on the plan’s PA list. Providers are directed to submit requests through the secure provider portal, PlanLink,…
Timely Filing Limit
Official provider materials contain two related filing statements: claims must be submitted within six months of the specified trigger dates, and the provider…
Community First Insurance Plans
Claims Submission
Community First supports claim submission through the Provider Portal and, for single claims, through Availity and Claim MD. The portal also supports claim…
Prior Authorization
Community First uses the Provider Portal for prior authorization requests and status review. For Medicaid/CHIP, the plan publishes general timelines and a…
Community Health Choice,
Claims Submission
Community’s provider claims guidance indicates multiple submission channels. For Marketplace/HIM electronic claims, the plan receives electronic transactions…
Prior Authorization
Community Health Choice states that prior authorization is required for non-emergent services when the plan requires it, and that authorization does not…
Timely Filing Limit
The provider claims billing guidelines state a 95-day timely filing deadline from the date of service for CMS-1500 claims or the date of discharge for UB-04…
Florida Health Care Plan,
Claims Submission
FHCP accepts electronic and paper claims. The public claims page instructs providers to submit electronically via payer ID 59322, through Availity, or paper…
Prior Authorization
FHCP states that many services do not require prior authorization, but prior authorization is required for certain non-emergency services and for care outside…
Timely Filing Limit
The official sources reviewed do not clearly state a universal timely filing deadline for initial claims. The provider resource guide does state that if a…
Friday Health Insurance Company,
Claims Submission
As of the official site notice, Friday Health Plans will no longer accept electronic claims submissions effective 10/01/2024; claims must be mailed to the…
Prior Authorization
No usable official prior-authorization policy or submission workflow specific to Friday Health Insurance Company, Inc. was found in the searched official…
Health First Commercial Plans,
Claims Submission
Health First exposes provider resources, a file exchange portal, and a member/provider portal entry point, but the accessible public sources here do not…
Prior Authorization
Officially, some services require prior authorization, and provider-directory materials say local network providers have the information on services that…
Health Options, Inc. dba Florida Blue
Claims Submission
Florida Blue states that network providers generally submit claims for members, while out-of-network/non-participating providers may require the member to…
Prior Authorization
Florida Blue states that prior authorization is required for certain services and some drugs; the specific requirements vary by plan, service, and line of…
Timely Filing Limit
Florida Blue public member documentation confirms a 16-month filing limit for network-provider claims in at least one Florida Blue plan document, and…
Health Plan of Nevada (HPN)
Claims Submission
HPN accepts paper claims by mail and electronic claims through a contracted clearinghouse. The provider portal supports claim status, claim submission-related…
Prior Authorization
HPN says all routine prior authorization requests for Health Plan of Nevada Inc. and Sierra Health and Life Insurance Company providers must be submitted…
Timely Filing Limit
HPN’s 2024 provider claims guide gives different filing windows by line of business and coordination-of-benefits scenario. Commercial claims are to be…
Highmark Blue Cross Blue Shield
Claims Submission
Highmark strongly steers providers to electronic submission via Availity Essentials. Claim status and claim inquiries are also handled in Availity, and claim…
Prior Authorization
Prior authorization is primarily handled through Availity Essentials / Availity’s Authorizations & Referrals workflow for initial medical authorization…
Timely Filing Limit
Highmark timely filing is generally 365 days in Pennsylvania, West Virginia, and New York, and 180 days in Delaware. Contracts can override these limits.
Hometown Health
Claims Submission
Hometown Health supports electronic claims submission using EDI Payer ID 88023 and provider self-service claim status checking through EpicCare…
Prior Authorization
Prior authorization is required for services on the applicable authorization matrices and medical benefit drug matrix. Contracted providers must submit prior…
Timely Filing Limit
Hometown Health states initial claim filing is 180 days from date of service, unless otherwise required by law. If Hometown Health is the secondary payer, the…
Imperial Health Plan
Claims Submission
Imperial accepts electronic and paper claims. Official provider materials indicate Imperial prefers electronic submission, partners with Office Ally for…
Prior Authorization
Prior authorization is submitted through the Imperial provider portal and, depending on line of business/state and request type, may also be accepted by fax,…
Timely Filing Limit
Imperial’s public transparency pages show a 90-day medical claim filing limit for AZ and TX Exchange enrollees. Provider manuals also state that participating…
Imperial Insurance Companies,
Claims Submission
Imperial accepts both electronic and paper claims, with a preference for electronic submission. The provider manual gives mailing addresses and Office Ally…
Prior Authorization
Imperial’s provider manual says providers must obtain authorization for all services not listed on the Direct Referral Form before delivering those services.…
Imperial Insurance Company
Claims Submission
Imperial’s provider-facing pages indicate claims status is available in the provider portal and provider services can be reached by phone. For member-facing…
Prior Authorization
Prior authorization is required for services not listed on the Direct Referral Form, and inpatient services always require prior authorization.…
Timely Filing Limit
Official public-facing materials found in the review clearly state member claim filing windows for some plan/state combinations, but provider-side timely…
Independent Health
Claims Submission
Independent Health’s official provider materials point providers to the secure provider portal and Transaction Assistant for HIPAA/EDI workflows, and some…
Prior Authorization
Independent Health uses prior authorization / preauthorization for selected services and drugs. The exact request path varies by product and delegated vendor:…
Timely Filing Limit
Independent Health publicly documented a temporary relaxation of timely filing deadlines in 2024 due to the Change Healthcare cyber event, with different…
Moda Health Plan,
Claims Submission
Moda supports electronic and paper claim workflows. Official provider materials identify electronic claim submission through direct EDI connections and…
Prior Authorization
Prior authorization requirements vary by line of business and service type. Moda provides service-specific authorization lists and an electronic submission…
Timely Filing Limit
Moda’s commercial provider manual sets a 365-day timely filing limit for initial claims. For secondary claims where Moda is secondary to another carrier, the…
Molina Healthcare
Claims Submission
Molina supports electronic claims submission through Availity Essentials/portal and through EDI clearinghouses in many markets. Paper claims are accepted in…
Prior Authorization
Prior authorization is required for some services, and Molina directs providers to state-specific provider manuals and authorization pages for the applicable…
Timely Filing Limit
Molina’s timely filing rules vary by state and product. Official materials reviewed show common windows such as 365 days from date of service for some…
Molina Healthcare of Florida
Claims Submission
Claims submission is supported through Molina’s Availity Essentials/provider portal and via EDI clearinghouse. For Florida Medicare Advantage, the manual…
Prior Authorization
Prior authorization is required for specified services and varies by line of business. Marketplace guidance for Florida indicates a digital-first process and…
Timely Filing Limit
Timely filing varies by line of business in the retrieved official materials. The Florida Medicare Advantage Provider Manual states a clean-claim timely…
Molina Healthcare of Texas,
Claims Submission
Molina Texas accepts claims electronically through its Provider Portal and through EDI clearinghouses using payer ID 20554. The provider manual says paper…
Prior Authorization
Molina’s Texas provider manual says prior authorization requests may be submitted through the Provider Portal, by fax, by phone, or by mail. Participating…
Timely Filing Limit
For Texas Medicaid/CHIP/MMP claims in the provider manual, Molina states that non-electronic claims must be submitted within 95 days of date of service, and…
Oscar Health Maintenance Organization of Florida,
Claims Submission
Oscar’s official provider pages indicate claims can be managed through the Provider Portal, and during the Change Healthcare disruption Oscar accepted claims…
Prior Authorization
Oscar states that in-network providers generally submit prior authorization requests on behalf of members. Providers can confirm requirements, submit…
Timely Filing Limit
Oscar did not surface a plan-wide Florida timely-filing rule in the official sources reviewed. The only explicit timely-filing language located was a Change…
Oscar Health Plan of North Carolina
Claims Submission
Oscar's official provider materials say the provider portal can be used to view claims, check claim status, and upload forms. The North Carolina provider…
Prior Authorization
Oscar states that in-network providers generally submit prior authorization requests on behalf of members. Providers can confirm whether a specific…
Timely Filing Limit
The official North Carolina provider welcome packet states the claims processing deadline for the state is 30 calendar days. A separate Oscar outage notice…
Oscar Health Plan,
Claims Submission
Oscar’s provider materials indicate claims and related work are managed through the Provider Portal, with portal access used for claims, eligibility, and…
Prior Authorization
Oscar states that in-network providers generally submit prior authorization requests on behalf of patients. Requests can be checked or submitted through the…
Oscar Ins Co of Texas
Claims Submission
Oscar provider resources indicate that claims can be viewed and managed in the Provider Portal. During the Change Healthcare outage, Oscar stated that claims…
Prior Authorization
Oscar states that in-network health care providers generally submit prior authorization requests on behalf of patients. Providers can use the Oscar Provider…
Oscar Insurance Company of Florida
Claims Submission
Oscar’s provider portal supports claims-related workflows, and Oscar states providers can submit claims by mail through standard processes. During the Change…
Prior Authorization
Oscar states that in-network providers generally submit prior authorization requests on behalf of patients. In Florida, providers can submit authorizations…
Timely Filing Limit
For Florida, Oscar’s state supplement says in-network providers should follow their contracts; absent a different contract deadline, the timely filing…
Oscar Insurance Corporation
Claims Submission
Oscar directs providers to use the Provider Portal for claims-related workflows, and its provider marketing/pages emphasize portal access for claims,…
Prior Authorization
Oscar indicates that in-network health care providers generally submit prior authorization requests on behalf of patients. Requests can be submitted or…
Scott and White Health Plan
Claims Submission
Claims can be submitted electronically through Availity or by paper mail. The official claims page lists a paper claims address, a claims refunds address, and…
Prior Authorization
Medical-benefit prior authorization is handled by BSWHP Health Services Division, and the site states that prior authorization does not guarantee payment. For…
Timely Filing Limit
For the commercial provider manual, initial claims must be received within 95 days of date of service. For COB claims, the 95-day clock runs from the primary…
Select Health
Claims Submission
Select Health supports electronic claims submission through EDI/UHIN and offers a Provider Benefit Tool for claims and eligibility review. The provider manual…
Prior Authorization
Select Health requires preauthorization requests to be submitted through its online preauthorization tools when available. The Commercial and Government…
Timely Filing Limit
For Select Health Commercial and Government plans, claims submitted directly to Select Health must be filed within 12 months of the date of service. The…
Sendero Health Plans,
Claims Submission
Sendero accepts electronic and paper medical/behavioral health claims. Electronic claims use ANSI-837 through Cognizant/Trizetto with EDI Payor ID MV440.…
Prior Authorization
Prior authorization is required for certain medical and behavioral health services. Sendero’s provider materials say requests may be submitted by the…
Timely Filing Limit
Sendero’s provider manual sets different timely-filing windows by claim type and by whether the claim is initial or corrected. For most initial claims, the…
SHA, LLC (FirstCare)
Claims Submission
FirstCare accepts electronic claims, paper claims, and portal-based claim status/redetermination functions depending on product. Commercial HMO/PPO and…
Prior Authorization
Prior authorization is required for certain services; FirstCare’s provider guidance says requests can be submitted through the provider portal or by fax, and…
Timely Filing Limit
FirstCare’s cited filing limits vary by line of business. Commercial HMO/PPO provider manual states claims must be filed within 95 days from date of service;…
SilverSummit Health Plan (Ambetter)
Claims Submission
SilverSummit supports electronic claim submission through EDI/clearinghouses and its secure web portal. The official payer ID is 68069. Paper…
Prior Authorization
Prior authorization is required for some services and is a condition of reimbursement for covered services subject to the plan’s authorization rules.…
Timely Filing Limit
For the Medicaid billing manual reviewed, initial claims and encounters must be received within 180 calendar days of date of service or date of eligibility.…
Simply Healthcare Plans dba WellPoint Florida,
Claims Submission
Electronic claim submission is the preferred operational channel. The provider manual supports X12 837 professional, institutional, and dental claims through…
Prior Authorization
For Florida commercial/individual-commercial providers, prior authorizations are submitted digitally using Availity Essentials. The provider manual also…
Timely Filing Limit
The provider manual does not state a single universal timely-filing number in the text reviewed; instead it says claims must be submitted within the…
Sunshine State Health Plan,
Claims Submission
Claims may be submitted electronically through Sunshine Health’s secure provider portal and via EDI. Sunshine Health lists payer ID 68069. Official pages also…
Prior Authorization
Prior authorization is required for certain services. Sunshine Health directs providers to use the Pre-Auth Check Tool to determine whether a service needs…
Timely Filing Limit
Sunshine Health’s Florida Medicaid provider guidance states the initial claim filing limit is 180 calendar days from date of service for participating…
Superior HealthPlan
Claims Submission
Superior allows electronic claim submission through the Secure Provider Portal or via clearinghouse EDI, and also accepts paper CMS-1500 and UB-04/CMS-1450…
Prior Authorization
Prior authorization requests can be submitted by phone, fax, or through the Secure Provider Portal. Superior says the portal is the preferred / encouraged…
Timely Filing Limit
For Medicaid/CHIP claims, Superior’s manual states outpatient claims must be received within 95 days of each date of service, inpatient hospital claims within…
U.S. Health and Life dba Ascension
UnitedHealthcare
Claims Submission
UnitedHealthcare supports claims submission through the Provider Portal, EDI, API, and paper/mail for some scenarios. Official guidance emphasizes digital…
Prior Authorization
UnitedHealthcare’s official provider materials direct providers to use the UnitedHealthcare Provider Portal to verify whether prior authorization is required,…
Timely Filing Limit
UnitedHealthcare filing limits vary by contract and plan. See the official limits found for initial and corrected claims, plus key exceptions.
UnitedHealthcare IC
Claims Submission
UnitedHealthcare supports electronic claim submission through EDI and the UnitedHealthcare Provider Portal; paper claims are also addressed in the…
Prior Authorization
UnitedHealthcare generally expects prior authorization requests to be submitted electronically. Official resources describe submission through the…
Timely Filing Limit
UnitedHealthcare says timely filing limits vary by state requirements and contract/participation agreement. For corrected claims, the corrected claim must be…
UnitedHealthcare of Arizona,
Claims Submission
Arizona Community Plan claims can be submitted electronically or on paper, and the provider portal is the main self-service channel for claims-related work.…
Prior Authorization
For Arizona Community Plan lines, prior authorization and notification requests are managed through the UnitedHealthcare Provider Portal. The Arizona…
Timely Filing Limit
UnitedHealthcare Arizona limits depend on the provider agreement. The manual reviewed gives 90 days for corrected claims in some cases.
UnitedHealthcare of Florida,
Claims Submission
Florida Medicaid claims can be submitted electronically, through the provider portal, or by mail in at least the behavioral analysis workflow documented by…
Prior Authorization
Prior authorization is required for certain covered services; for Florida Medicaid, UnitedHealthcare directs providers to use the UnitedHealthcare Provider…
Timely Filing Limit
UnitedHealthcare Florida filing limits depend on the provider agreement. The Medicaid manual reviewed gives 90 days to correct rejected claims.
UnitedHealthCare of Texas,
Claims Submission
Texas Community Plan claims can be submitted electronically via EDI, through the UnitedHealthcare Provider Portal, or on paper to the plan’s mailing address.…
Prior Authorization
Prior authorization rules vary by line of business and service type. For Texas Community Plan/Medicaid products, UnitedHealthcare says prior authorization…
Timely Filing Limit
UnitedHealthcare Texas Community Plan materials use 95 days from service for initial claims. Contract and coordination-of-benefits rules can differ.
Univera Healthcare
Claims Submission
Univera accepts claims through electronic and paper workflows. The provider portal supports claim status review and claim adjustments. For electronic claims,…
Prior Authorization
Prior authorization is required for some treatments, medications, and procedures. Univera directs providers and members to the current prior authorization…
Timely Filing Limit
Univera’s public provider materials indicate that most participating provider agreements include a filing limit and that claims submitted after the time limit…