Frequently Asked Questions
What is your Payer ID for Providence Preferred?
Check your clearinghouse's website for their Payer ID list. Providence Preferred and Providence Health Plan have separate Payer IDs. If the Payer ID list is not available on the website, email us at PHPEDISupport@providence.org.
Why was my claim file rejected at the clearinghouse?
Make sure the Payer ID is for Providence Preferred PPO and not Providence Health Plan. Some edits are different for PPO and will cause the files to reject.
One of the most common reason claims are rejected is because the provider is not submitting their claims with the 10 digit NPI. There is an EDI hard coded edit that will only take a ten digit electronic provider number.
Are you sending the tax ID number in the NPI field?
I'm sending my claims to the clearinghouse, so why is Providence PPO getting paper claims?
Check with the clearinghouse to see if they have you set up for PPO electronic claims. Sometimes there is an enrollment process that needs to be completed with the clearinghouse before they submit your claims electronically.
What is my provider number for electronic claims?
Providers can use their individual provider NPIs effective April 10, 2007. The provider number is the same as the Providence Health Plan provider number for electronic claims.