Payer ID
Varies — confirm via portal / clearinghouse
No single published professional-claims payer ID; EDI routes through Edifecs and most claims go to the member's participating provider group (PPG) per the ID card.
Timely Filing Limit (TFL)
180 calendar days from date of service (90 days from primary's decision if secondary)
Appeal Window
Provider Dispute Resolution within 365 days of most recent claim decision
Clearinghouse
Edifecs (EDI gateway)
Provider Services
855-315-5800
Claims Fax
Varies — confirm via portal / clearinghouse
Claims Address
Out-of-area emergency (non-par): P.O. Box 211553, Eagan, MN 55121; all other claims to member's PPG per ID card
Provider Portal
https://shplan.org/providerportal
Northern California commercial HMO, rebranded from Sutter Health Plus. Most claims route to the member's PPG.
Values vary by plan, region, and contract and can change. Confirm in the payer portal or with your clearinghouse before filing.
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