Billing and claims

Following is how to process billing and claims for contracted providers.

Please review our Clinical Editing Reimbursement Policy (RPM002)  for details. See also all the policies in our Reimbursement Policy Manual for more assistance.

Electronic claims and transactions

We encourage electronic claim submission for quicker submission, higher accuracy, better tracking and lower administrative costs.

Direct connection to Summit Health

We support direct connections between our offices, provider offices and health systems. The transaction standard is the 837 Professional Claim or 837 Institutional Claim required by HIPAA Administrative Simplification. For help with Summit Health EDI transactions, either contact us or send an email.

Claims clearinghouses

Below are claims clearinghouses we use:

Availability
12400 Coit Rd. #700 / Dallas, TX 75251 / 800-282-4548 / Payor ID = 13350

Change Healthcare (formerly Emdeon) (both medical and hospital)
3055 Lebanon Pik / Nashville, TN 37214 / (615) 932-3000 / Payor ID = 13350

MCPS Inc
1740 S. Glenstone #B / Springfield, MO 65804 / 417-890-6164

MD On-Line Inc.
6 Century Dr. / Parsippany, NJ,07054 / 888-499-5465

Office Ally
P.O. Box 872020 / Vancouver, WA 98687 / 360-975-7000

Payer Connection
P.O. Box 1769 / Lake Oswego OR 97035 / 503-820-3803

Relay Health
(both medical and hospital) 301 Data Court / Dubuque, IA 52003 / 800 527-8133

Systems that submit directly to Summit Health:

LINCARE Inc.
19387 US 19 N / Clearwater, FL 33764 / 727-431-8231

Mailing address

Summit Health Plans, Inc.
Attn: Medical Claims
P.O. Box 820070
Portland, OR 97282

Pharmacy Claims
P.O. Box 1039
Appleton, WI 54912-1039