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:
Please note that as of January 1st, 2020, Advanced Health will process all claims for mental health services directly. Claims related to substance abuse treatment must still be submitted to the appropriate delegated entity as outlined below:
Coos County Residents:
- Effective December 23rd, 2019 – Please submit all mental health Claims for Coos County residents directly to Advanced Health for payment (regardless of date of service). Coos Health and Wellness & PH-Tech will no longer accept claim submissions after December 22nd, 2019.
- Please continue to submit claims for substance abuse treatment to ADAPT. Please contact ADAPT directly prior to rendering services whenever possible. They can be reached by phone at 541-672-2691.
Curry County Residents:
- Effective January 1st, 2020 – Please submit all mental health Claims for Curry County residents directly to Advanced Health for dates of service on or after January 1st, 2020. For dates of service prior to January 1st, 2020, please continue to submit claims to Curry Community Health.
- Please continue to submit claims for substance abuse treatment to Curry Community Health. Please contact Curry Community Health directly prior to rendering services whenever possible. They can be reached by phone at 541-425-7545.
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
VisibilEDI Provider Portal Overview
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 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 York 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 ___________________________________________________________________________________________________________________________________________________
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:
P.O. Box 705
Elk Grove Village, IL 60009
All other correspondence (including refunds) should be addressed to:
289 LaClair St
Coos Bay, OR 97420
Claims department contact info:
Please note that we cannot accept claim submissions via fax. Any unsolicited claims received via fax will be securely destroyed without response.