Sentara Health Plans
Also covers / subsidiaries: Optima Health, Virginia Premier
Core Payer & Clearinghouse Profile
Electronic Payer ID
00453
EDI payer ID 54154 (Sentara Health/Optima Health); some legacy lines may use different IDs.
Timely Filing Limit (TFL)
365 days from date of service for initial claims
Appeal Window
Varies — confirm via portal / clearinghouse
Clearinghouse Gateway
Availity; also Veradigm and Change Healthcare
Provider Services
800-229-8822
Claims Fax
Varies — confirm via portal / clearinghouse
Claims Address
Medical: PO Box 8203, Kingston, NY 12402-8203; Behavioral health: PO Box 8204, Kingston, NY 12402-8204
Provider Portal
https://www.sentarahealthplans.com/en/providers/provider-portals
Virginia-based; formerly Optima Health. Also Medicaid (Sentara Community Plan) and Medicare.
National EDI Clearinghouse Capabilities
Direct ANSI X12 electronic transaction support verified for Sentara Health Plans.
Associated Clearinghouse Payer IDs
National clearinghouse networks maintain dedicated routing IDs for specific transaction lines or subsidiaries under Sentara Health Plans.
| Clearinghouse Name | Electronic Payer ID | Status | Enrollment | Supported Services |
|---|---|---|---|---|
| Optima Health | 00453 | Non-Par | None | 837I |
| Optima Health | 10477 | Non-Par | None | 837P837I270/271Dental |
| Optima Health Management | 54154 | Non-Par | Required | 837P837I835 ERA |
| Optima Health Plan | 54154 | Par | None | 837P837I835 ERA |
| Optima Insurance Company | 54154 | Par | None | 837P837I835 ERA |
| Sentara Family Care | 54154 | Par | None | 837P837I835 ERA |
Resolution Tools for Sentara Health Plans 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 Sentara Health Plans Denials & Delayed Payments?
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