Sutter Health Plan
Also covers / subsidiaries: Sutter Health Plus, SHP
Core Payer & Clearinghouse Profile
Electronic Payer ID
13287
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 Gateway
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.
National EDI Clearinghouse Capabilities
Direct ANSI X12 electronic transaction support verified for Sutter Health Plan.
Resolution Tools for Sutter Health Plan 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 Sutter Health Plan Denials & Delayed Payments?
Aethera's billing specialists work Sutter Health Plan every day — handling EDI clearinghouse rejects, prior authorizations, payment posting, and 30-day AR aging recovery.