How To Submit Claims To SilverSummit Health Plan (Ambetter)

SilverSummit Health Plan (Ambetter)'s reviewed provider guidance starts with this submission channel: EDI. Confirm the member plan and claim type before using a payer ID or paper 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