Healthcare Solutions Portal

Payers


The payers listed below require Special Enrollment, and are not immediately available to providers. Special Enrollment involves submitting information and/or paperwork via email, fax or online and is the only way providers can enroll to use eligibility EDI services for these payers. Please be advised that special enrollment is a process that is separate from a provider registering their NPI with the payer (see ‘Note about your NPI’ below). Contact and mailing information for enrollment submission is located at the bottom of the Special Enrollment section.
 
A note about NPI: Register Your NPI with your health plans. Providers must ensure they have correctly registered their Group Level NPI (National Provider Identifier) with any applicable health plans. FinThrive is not responsible for registering individual NPI numbers or verifying the accuracy of the NPI registered for a given provider.
 
BCBS Plans: Enrollment through any BCBS plan outside of your provider’s state will not be required as the enrollment will likely reject. All providers should submit through the local BCBS plan for their state as the Blue Exchange network allows transactions for out-of-state members to route to the appropriate destination.
Payer Instructions Estimated Timeframe Documentation
Aetna

Aetna requires specific NPI registration for all electronic transactions. Please submit the NPI directly via the NPI Submission Form on the Aetna website and view the attached documents which define this requirement and process in detail.

Questions regarding the NPI registration and enrollment process should be directed to Aetna's provider line at 1-888-632-3862.

 2-5 business days
AgeWell NewYork *

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 
 3-5 business days
Alameda Alliance Health Plan *

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 
 3-5 business days
BCBS of Delaware

Please open an Insurance Eligibility support case and provide the following fields:

  • Provider name
  • Group level NPI
  • Provider Facility State

Note: All out of state NPIs will be automatically rejected.

1-3 weeks
BCBS of Michigan (Professional)

Follow the below BCBS of Michigan (Professional & Institutional) enrollment instructions:

  1. Visit https://editest.bcbsm.com/tpalogon.html
  2. Enter your TPA User ID and password.
    1. Note: If a provider is unable to login, that means the user ID and password are invalid. Provider should call BCBS MI to obtain their correct user ID and password – 800.542.0945, option 3 or email EDISupport@bcbsm.com.
    2. Note: If a provider doesn’t know their User ID and password, they can contact BCBS MI at 800.542.0945, option 3 or email EDISupport@bcbsm.com to obtain their TPA User ID and PW.
  3. Once you are logged in, choose Professional Provider Authorization or Institutional Provider Authorization.
  4. Then enter the following information:
    • Provider ID (PIN) = Leave this field blank
    • NPI = Provider or Organization’s NPI
    • Source of Payment = Blue Cross Blue Shield
    • Submitter ID = c0ina (note the zero) for Professional Providers
    • Submitter ID = 204202692 for Institutional Providers
    • Unique Receiver ID = Leave this field blank
    • Provider email address = Confirmation will go to this email

     5. Click Submit

After completing the steps above, BCBS MI will send a confirmation email that the enrollment will become effective in 48 hours. The payer will not send another email. Transactions should work in 48 hours.

 2 business days
BCBS of Pennsylvania (Highmark) [Institutional]

Please open an Insurance Eligibility support case and provide the following fields:

  • Provider name
  • Group level NPI
  • Provider Facility State

Note: All out of state NPIs will be automatically rejected.

 1-3 weeks
BCBS of Pennsylvania (Highmark) [Professional]

Please open an Insurance Eligibility support case and provide the following fields:

  • Provider name
  • Group level NPI
  • Provider Facility State

Note: All out of state NPIs will be automatically rejected.

 1-3 weeks
BCBS of West Virginia

Please open an Insurance Eligibility support case and provide the following fields:

  • Provider name
  • Group level NPI
  • Provider Facility State

Note: All out of state NPIs will be automatically rejected.

1-3 weeks
Blue Cross Pennsylvania (Capital)

Follow the enrollment instructions below for Blue Cross Pennsylvania (Capital).

  1. Visit 

    https://www.capbluecross.com/wps/portal/cap/provider/edi-enrollment

  2. Select the applicable EDI transaction (Eligibility - ANSI 270/271 and/or Claim Status - ANSI 276/277).
  3. Complete the remaining required fields noted with an asterisk*.

Clearinghouse information, please add FinThrive fka TransUnion Healthcare as your clearinghouse.

 2 weeks
Brand New Day

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 3-5 business days
California Medicaid (Medi-Cal)

No special enrollment, but the provider's pin (6, 7, or 8 digits) must be sent on ALL transactions.

You can validate the NPI/PIN combination by entering them as UserID and password, at

 https://secure.medi-cal.ca.gov/mcwebpub/login.aspx

 N/A
Care1st of California

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 
 
 3-5 business days
Central Health Medicare Plan

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 
 3-5 business days
Coastal Management Services-Aspire*

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 3-5 business days
Consolidated Health Plan*

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 3-5 business days
Delta Health Systems *

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 3-5 business days
HealthPartners (MN)

Please open an Insurance Eligibility support case and provide the following fields:

  • Provider Name (Group)
  • Physical Address
  • NPI (Group level)
  • TIN (Group level)
 1 week
Highmark Senior Solutions

Please open an Insurance Eligibility support case and provide the following fields:

  • Provider name
  • Group level NPI
  • Provider Facility State

 *WV providers only

Note: All out of state NPIs will be automatically rejected.

 1-3 weeks
Iowa Medicaid

Iowa Medicaid enrollment instructions:

Providers will need to logon to the EDISS Connect Portal to complete the enrollment:

Visit https://connect.edissweb.com/

Follow the instructions in the attached document. 

 1 Business day
Kaiser Foundation Health Plan of Colorado

Enrollment Requirement for ALL Kaiser Health Plans:

New Providers Only must be enrolled. Providers that are already submitting are exempt.

Please open an Insurance Eligibility support case and provide the following fields:

  • Name of Provider
  • Physical Address
  • Contact Name
  • Contact Phone
  • Contact Email
  • Provider ID / NPI
  • Tax ID
 2 weeks
Kern Health Systems *

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 3-5 business days
Maryland Medicaid

Enrollment form must be filled out with original/physical signature.

Mail completed form to:

ATTN: HIPAA DESK

Systems Liaison Services

201 W. Preston St., RM SS-18

Baltimore, MD 21201

 

 2-3 business days
Massachusetts Medicaid Massachusetts Medicaid Enrollment Instructions 

Providers are responsible for contacting MassHealth by emailing EDI@masshealth.net with the following information to enable setup or changing their billing intermediary.


A request containing the following information should be submitted on the provider's letterhead:

Current Date

MassHealth Provider ID / Service Location (PID/SL)

National Provider ID (NPI) Number

Vendor Name

Vendor's MassHealth Submitter ID (PID/SL) if sending and receiving transactions through a Billing Intermediary / Clearinghouse

Signature with printed / typed name

Brief explanation of the request with the type of transactions specified

Providers may either scan or email the letter to EDI@MAHealth.net or fax it to 617-988-8971.

Once MassHealth receives the requested information, your MassHealth EDI Enrollment request will be processed.  We send a conformation back to the provider to let them know that the enrollment request has been processed.

Vendor Name: Optum Insight

Massachusetts Medicaid PID/SL: 110210691A
 2 - 4 weeks
Medicare (Part A & B)

Before submitting to Medicare, FinThrive Healthcare must verify your NPI with CMS.

If you have already selected Medicare as a payer, we have been alerted to validate your NPI with Medicare; if you receive a rejection on Medicare transactions, please open an Insurance Eligibility support case for assistance.

 2-3 business days
Medicare (Part A & B) – MBI Lookup & Eligibility

Before submitting to Medicare, FinThrive Healthcare must verify your NPI with CMS.

If you have already selected Medicare as a payer, we have been alerted to validate your NPI with Medicare; if you receive a rejection on Medicare transactions, please open an Insurance Eligibility support case for assistance.

2-3 business days
Medicare (Part A & B) – SSN/MBI Lookup & Eligibility

Before submitting to Medicare, FinThrive Healthcare must verify your NPI with CMS.

If you have already selected Medicare as a payer, we have been alerted to validate your NPI with Medicare; if you receive a rejection on Medicare transactions, please open an Insurance Eligibility support case for assistance.

 2-3 business days
Medicare Advantage - Pennsylvania

Please open an Insurance Eligibility support case and provide the following fields:

  • Provider name
  • Group level NPI
  • Provider Facility State

Note: All out of state NPIs will be automatically rejected.

1-3 weeks
Michigan Medicaid

Providers will need to logon to Michigan Medicaid’s CHAMPS system and associate both Billing Agent ID's 2243495 and 1630780 with their group level NPI.

How to Questions for the website should be referred to Michigan Medicaid, Provider Enrollment Support, 800-292-2550 option #4

CHAMPS website:

https://milogintp.michigan.gov


. 		2 business days
Michigan Medicaid Pending Eligibility

Providers will need to logon to Michigan Medicaid’s CHAMPS system and associate both Billing Agent ID's 2243495 and 1630780 with their group level NPI.

How to Questions for the website should be referred to Michigan Medicaid, Provider Enrollment Support, 800-292-2550 option #4

CHAMPS website: https://sso.state.mi.us/

2 business days
Nebraska Medicaid

Please open an Insurance Eligibility support case and include the completed enrollment form(s).

To ensure there are no additional delays, please confirm that the provider taxonomy and zip+4 included on the enrollment forms are identical to the taxonomy and zip+4 the payer has on file for that particular provider. Incorrect or inaccurate information included on enrollment forms will result in a payer rejection.

Please also note that Nebraska Medicaid enrollment forms should be completed with group level information only.

2 weeks
North Carolina Medicaid

While 270/271 eligibility transactions do not require special enrollment for NC Medicaid, a special enrollment process is required for 276/277 claim status transactions. 

To complete the enrollment for 276/277 transactions, credentialed providers will need to log into the NCTracks portal and associate our numeric billing agent ID (50300605) to their NPI via the "Manage Change Request" section of the portal. Please see the attached instructions regarding how to associate your NPI to our billing agent ID.
Texas Medicaid - Long Term Care

Texas Medicaid – Long Term Care

Texas Medicaid - Long Term Care requires a three-step enrollment process for EDI transactions. If the provider has completed any of the earlier steps, they may simply skip to the next relevant step.

Step 1 (Contracting with Texas Medicaid - Long Term Care):

Providers must be contracted with this payer before submitting an enrollment. To contract with Texas Medicaid - Long Term Care, providers can visit the DADS website at: http://www.dads.state.tx.us/providers/. Providers can also contact DADS Provider Enrollment at Texas.Medicaid.Enrollment@dads.state.tx.us. Once DADS processes the contract application, the provider will be given a “Contract Number”.

Step 2 (Completing the EDI Agreement):

The provider is required to submit an EDI Agreement form to Texas Medicaid. Providers with a valid Contract Number that have not completed the EDI agreement form must do so by completing the following Electronic Data Interchange Agreement for Long Term Care Providers: Texas Medicaid EDI Trading Partner Agreement.  Once completed, the form must be mail it to TMHP at the following address:

Texas Medicaid & Healthcare Partnership

Attention: EDI Help Desk, MC–B14

PO Box 204270

Austin, TX 78720-4270

Step 3 (Completing the Submitter ID Linking Form):

Providers with a valid Contract Number will then need to fill out a Submitter ID linking form: TX Medicaid Submitter ID Linking Form. The provider will need to fill out all sections on this form.

Section I. Provider Number field must contain the providers “Contract Number” not the provider’s NPI.

Section II, Submitter ID: is 146215201 and “I want to link this Submitter ID and Provider Number” box should be checked

*Please note, the Submitter ID Linking form is annexed to the EDI Agreement and can, therefore, be submitted to the payer concurrently with the EDI Agreement if the provider has not completed step 2.

If the provider has any questions/issues about any of the steps during this enrollment process, they can get help directly from Texas Medicaid EDI by calling The TMHP EDI Helpdesk at 1-888-863-3638 option 4.

 

 Up to 2 months for new providers & 30 days providers completing step 3 only.
University Health Alliance*

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 3-5 business days
Upper Peninsula Health Plan

Providers will need to logon to Michigan Medicaid’s CHAMPS system and associate both Billing Agent ID's 2243495 and 1630780 with their group level NPI.

How to Questions for the website should be referred to Michigan Medicaid, Provider Enrollment Support, 800-292-2550 option #4

CHAMPS website:

https://milogintp.michigan.gov

 
 2 business days
Utah Medicaid

Utah Medicaid enrollment instructions:

Providers will need to logon to the PRISM Portal to complete the enrollment:

Visit https://medicaid.utah.gov/accessing-prism/

Follow the instructions in the attached documents. 

 2 - 4 weeks
Village Care Max

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 3-5 business days
Western Growers Assurance Trust *

Web Credentials Required.

Submit a request for enrollment using your web portal "Web Credentials" page.

Refer to the Web Credential Enrollment guide for more details.

 3-5 business days
 
Enrollment Information:

FinThrive
Phone: 800-390-7459


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