Claim Submissions

ALERT! Timely Filing Change:

Effective January 1st, 2020, Advanced Health will require that all claims must be submitted within 120 days of the date of service in accordance with Oregon Administrative Rule 410-141-3420.  A 12-month timely filing period will still be allowed in some circumstances such as Pregnancy or primary Medicare coverage.  No payment will be issued for claims received more than 12 months from the date of service. Please note that this applies to both participating and non-participating providers. __________________________________________________________________________________________________________________________________

ALERT! Mental Health Claims:

Mental health claims for Coos County residents must be submitted to Coos Health and Wellness directly for payment.  They work with PH-Tech to receive electronic claims.  Their payer ID is WOAHM.  Please contact Coos Health & Wellness prior to rendering services whenever possible.  They can be reached at 541-266-6768. Mental health and substance use/chemical dependency claims for Curry County residents must be submitted to Curry Community Health on paper.  Please contact Curry Community Health directly prior to rendering services whenever possible.  They can be reached at 541-425-7545.

The following information pertains to physical health claims only: ___________________________________________________________________________________________________________________________________________________

NEW! Claim Status Inquiry:

Providers with access to our web portal may now check the status of submitted claims securely online.  Look for the Claim Status button in the menu.  If you would like to enroll in the portal, please read the following instructions: Online User Registration For all other providers, please complete and submit the following form: Claim Inquiry Form (fillable PDF) For additional information, please see the following document: Claim Inquiry Process  ___________________________________________________________________________________________________________________________________________________

ALERT! Provider Configuration:

Before we can accept any claim, all providers on that claim (billing, rendering, referring, ordering, prescribing, attending, etc.) must first have a valid Oregon Medicaid ID effective on the date of service.  Providers must also not be present on the Office of the Inspector General’s (OIG) exclusion list.  These are State and Federal requirement and cannot be circumvented.  Please visit the Oregon Health Authority’s provider enrollment website at https://www.oregon.gov/oha/HSD/OHP/Pages/Provider-Enroll.aspx for additional details. If you would like Advanced Health to apply on your behalf, please complete this application: Oregon Medicaid ID Application Packet.

Note: To provide services to OHA Fee For Service clients, you must enroll with OHA directly. Additionally, all providers and vendors must be configured in our claims processing system prior to claims submission.  Please follow the instructions on our Provider Registration form to initiate this process. ___________________________________________________________________________________________________________________________________________________

NEW! Electronic Claim Submission:

Advanced Health now accepts electronic claims (837P & 837I) for professional and institutional billing for both primary and secondary claims. We work closely with Trizetto Payer Solutions and their many trading partners for electronic claims submission.

The payer ID for professional is DOCSO (all alpha characters) The payer ID for institutional is UOCSO (all alpha characters).

For questions or issues regarding electronic claim submissions, please contact the Advanced Health account representative at Trizetto Payer Solutions:

Kristie Ludgate Senior Account Manager, TTPS
Office: (800) 969-3666 Ext. 1538
Fax: (314) 802-5039
Email: Kristie.Ludgate@trizetto.com ___________________________________________________________________________________________________________________________________________________

NEW! CMS Medicare Crossover Claims:

In March of 2018, CMS began forwarding claims to Advanced Health for dual-eligible members who are enrolled in both plans.  Your remittance from CMS may indicate that the claim has crossed over to Oregon Medicaid (not WOAH or Advanced Health).  All claims should cross over, however there will all ways be exceptions.  To minimize duplicate claim submissions, please allow sufficient processing time (45 days) before submitting your Medicare primary claims to Advanced Health.  In the meantime, registered users can use the claims status function of our web portal (see details above) to determine if we have received a claim from CMS prior to submitting. ___________________________________________________________________________________________________________________________________________________ Paper Claim Submission: Please submit electronic claims whenever possible!

Please note that claims submitted on paper may have significantly longer processing times.  If you are unable to bill electronically, you may send paper claims to the following address:

Advanced Health
Claims Department
P.O. Box 705
Elk Grove Village, IL 60009

All other correspondence (including refunds) should be addressed to:

Advanced Health
289 LaClair St
Coos Bay, OR 97420

Claims department contact info:
Phone: 541-269-0567
Fax: 541-266-0141

Please note that we cannot accept claim submissions via fax.  Any unsolicited claims received via fax will be securely destroyed without response.