Ascension_Personalized_Care_ACA_health_plan_Submitting_a_Claim_clinicians

Submitting a Claim

Claim filing procedures

How to file a claim for professional services

Claims should be submitted as follows: 

What Where How
In-Network: Claims must be received by Ascension Personalized Care within 180 days from the date of service. Claims received outside of this timeframe will be denied for untimely submission.
 Submit electronic claims to one of the vendors below.** Electronic Claims:
Submit under Payer ID 38259**
Out-of-network - Indiana, Kansas, Tennessee and Texas:
Claims must be received by Ascension Personalized Care within 95 days from the date of service. Claims received outside of this timeframe will be denied for untimely submission.
 Submit electronic claims to one of the vendors below.** Electronic Claims:
Submit under Payer ID 38259**
Out-of-network - Michigan:
Claims must be received by Ascension Personalized Care within 60 days from the date of service. Claims received outside of this timeframe will be denied for untimely submission.
 Submit electronic claims to one of the vendors below.** Electronic Claims:
Submit under Payer ID 38259**

**EDI clearing houses currently contracted: Change Healthcare

To avoid rejected claims, please include:

• Member ID number 

• Patient’s name

• Patient’s birth date and sex

• Insured’s group number 

• Indication of auto - employment - emergency related condition (when applicable)

• Pre-certification number - include referral or precertification when applicable

• Name of referring doctor. If the patient self-referred, type “self”

• Diagnosis code (ICD-10) 

 

• Date of service

• Procedure code (CPT or HCPCS when applicable, with appropriate modifiers)

• Billed charges

• Number of units

• Total charges

• Provider tax ID number

• Provider NPI number 

• Provider’s billing address and phone number

Ascension Personalized Care will return claims missing any of the above information to the doctor for completion.

Electronic transmissions

Ascension Personalized Care has the ability to receive direct Electronic ANSI X12 EDI Transmissions via our Direct Portal established through Change HealthCare. The process can be initiated by submitting an email to Ascension Personalized Care at
edisupport@abs-tpa.com with the information below. Once the information is received, we will have a representative contact you and begin the implementation process. For those providers not set up electronically, Change HealthCare also makes available an online data entry system that allows providers the ability to enter and submit claims. Information on this process is available upon request.

The information needed to provision includes:

• Submitter name

• ISA06 (sender ID) – usually tax ID 

• Contact name

• Contact email 

• Contact phone

• Transfer method (manual or SFTP)

Ascension_Personalized_Care_ACA_health_plan_Submitting_a_Claim_clinicians_list

Provider Portal

Please visit the ABS Provider Portal to verify eligibility and view claims history and payment status. New to the ABS Provider Portal? In order to gain access to this secure website, please complete and return the ABS Provider Web Portal Access Application form via email to abssupport@abs-tpa.com.