Claim Submissions

Contact Information

Claims Department Contact Info:
Phone: 541-269-0567
Fax: 541-266-0141

Electronic Payer IDs:
837P / CMS 1500 format: DOCSO
837I / UB-04 format: UOCSO

Claims Mailing Address:
Advanced Health
Po Box 241866
Apple Valley, MN 55124

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

Advanced Health
289 LaClair St
Coos Bay, OR 97420

Claim Appeals

Advanced Health Claims Appeal Form

Claim appeals can be sent to the following email: claim.appeals@advancedhealth.com

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 410-141-3565.  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! Behavioral Health Claims:

Advanced Health processes all claims for mental health services directly. Please submit claims for these services electronically (or on paper if necessary) using the instructions on this page.

Claims related to substance abuse treatment must be submitted to ADAPT. Please contact ADAPT directly prior to rendering services whenever possible to coordinate care and obtain prior authorization. They can be reached by phone at 541-672-2691. Ask for Debbie.

Please submit substance abuse claims to:

ADAPT
PO BOX 1121
Roseburg, OR 97470
Phone: 541-672-2691
Fax: 541-673-5642
adaptoregon.org/contact

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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. ___________________________________________________________________________________________________________________________________________________

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 Provider 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 Provider Solutions:

Elisha Wooten Account Manager, TTPS
3300 Rider Trail South
Earth City, MO 63045
Office: (800) 969-3666 Ext. 3361
Fax: (314) 802-5039
Email: Elisha.York@Cognizant.com ___________________________________________________________________________________________________________________________________________________

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 be able to mail paper  claims to the address listed above. Please submit electronic claims whenever possible.

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