How To Submit Claims To SilverSummit Health Plan (Ambetter)

For SilverSummit Health Plan (Ambetter), the practical claims workflow usually starts with electronic submission guidance and only falls back to paper instructions when the payer documents a mailing address for specific claim types or exceptions. The details below keep the workflow broad instead of reducing it to a single address.

At a glance

• SilverSummit supports electronic claim submission through EDI/clearinghouses and its secure web portal. The official payer ID is 68069. Paper claims/encounters go to the Farmington, MO claims address. Corrected claims must include the original claim number and frequency code; the provider manual says corrected claims may be submitted via the website or in writing to the corrected-claims address.

Submission channels

• EDI
• secure web portal
• paper claim submission
• corrected claim submission via website or mail

Electronic claims payer IDs

• 68069

Paper claims addresses

• SilverSummit Healthplan, Attn: Claims Department, PO Box 5090, Farmington MO 63640-5090
• SilverSummit HealthPlan, Attn: Corrected Claim, PO Box 5090, Farmington MO 63640-5090

Corrected claims and follow-up

• Include the original claim number in field 22 of CMS-1500 or field 64 of UB-04.

• Include the frequency code.

• Failure to include the original claim number and frequency code may result in duplicate denial, reprocessing delay, or denial for exceeding timely filing.

• The manual says adjusted or corrected claims may be submitted via the website or in writing to the corrected-claim address.

• Claims status resource 1

• Claims status resource 2

Caveats

• The official electronic-transactions page lists Availity, Change Healthcare, and McKesson as clearinghouse vendors; the 2022 manual also mentions Envoy, WebMD, Availity, and TriZetto. This suggests vendor lists change over time, so use the current portal/clearinghouse guidance before filing.
• A newer provider billing manual exists on the provider manuals page; the paper address and EDI payer ID were confirmed from official sources, but current filing instructions should still be validated against the latest manual.
• The provider portal offers claims functions, but the exact workflow for corrected claims/appeals may differ by claim status and line of business.

Provider resources

• Provider Resources landing page (official)
• Provider Manuals (official)
• Prior Authorization (official)
• Electronic Transactions (official)
• Provider Toolkit (official)
• Provider Portal login (official)
• Medicaid Pre-Auth tool (official)
• TurningPoint cardiac program notice (official)

Sources