MetroPlusHealth
Also covers / subsidiaries: MetroPlus Health Plan, MetroPlus
Core Payer & Clearinghouse Profile
Electronic Payer ID
13265
Payer ID 13265 for MetroPlusHealth professional and institutional claims (now via Availity). (New York)
Timely Filing Limit (TFL)
90 days from date of service or discharge
Appeal Window
Varies — confirm via portal / clearinghouse
Clearinghouse Gateway
Availity (primary since 2024; payer ID 13265)
Provider Services
800-303-9626
Claims Fax
Varies — confirm via portal / clearinghouse
Claims Address
MetroPlusHealth, P.O. Box 219080, Kansas City, MO (verify ZIP/suite on the current claims page)
Provider Portal
https://metroplus.org/providers/
New York City Medicaid/Marketplace/Medicare plan affiliated with NYC Health + Hospitals.
National EDI Clearinghouse Capabilities
Direct ANSI X12 electronic transaction support verified for MetroPlusHealth.
Associated Clearinghouse Payer IDs
National clearinghouse networks maintain dedicated routing IDs for specific transaction lines or subsidiaries under MetroPlusHealth.
| Clearinghouse Name | Electronic Payer ID | Status | Enrollment | Supported Services |
|---|---|---|---|---|
| Metroplus | 10846 | Non-Par | None | 276/277 |
| Metroplus Health Plan | 13265 | Non-Par | Required | 837P837I835 ERA |
| Metroplushealth | 13265 | Non-Par | None | 837P837I835 ERA |
Resolution Tools for MetroPlusHealth Claims
Values vary by plan, line of business, and provider agreement. Confirm in the payer portal or with your clearinghouse gateway before submitting electronic claims.
Tired of Chasing MetroPlusHealth Denials & Delayed Payments?
Aethera's billing specialists work MetroPlusHealth every day — handling EDI clearinghouse rejects, prior authorizations, payment posting, and 30-day AR aging recovery.