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.
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.
The tax ID should be in box 25 and the provider number in box 33 pin# on the HCFA-1500 form. If you cannot determine why the claim was rejected please contact us at PHPEDISupport@providence.org.
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.
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.