Clover Health at a glance
| Legal name | Clover Health, Inc. |
|---|---|
| Also known as | Clover |
| Category | Medicare Advantage |
| Parent organization | Clover Health Investments, Corp. |
| Claims payer ID | Clover lists current claims ID 13285 for named clearinghouses with Smart Data Solutions arrangements. Confirm the listed clearinghouse or its SDS arrangement; this is not a universal transaction identifier. |
| Eligibility (270/271) payer ID | Stored eligibility references remain unverified for the current product and transaction. A claims identifier must not be reused for 270/271 routing. |
| ERA (835) payer ID | 77023 — registry reference; verify the member product, transaction and clearinghouse. Not verified: Stored ERA references remain unverified for the current product, clearinghouse and enrollment. This claims comparison does not establish an 835 identifier. |
| NAIC company code | Not established in this registry |
| States covered | New Jersey, Texas, Georgia, South Carolina, Alabama, Arizona, Mississippi, Pennsylvania, Tennessee |
| Members covered | ~80k members |
| Provider resource entry point | https://www.cloverhealth.com/en/providers |
| Provider phone | 1-888-778-14781-888-778-1478 is labelled member services. A provider-support replacement was not verified in this comparison. |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for Clover Health
This registry lists 365 days as an initial-claim reference for Clover Health. Confirm the applicable product, provider agreement, start event and current payer instructions. Do not apply this value automatically to out-of-network, secondary, corrected or appealed claims.
| Submission type | Window |
|---|---|
| Initial claim reference | 365 days (verify applicability) |
| Out-of-network initial claim | Verify the member's plan and applicable out-of-network rules |
| Secondary / coordination of benefits | Verify the allowed window and start event; a primary EOB does not automatically restart filing |
| Corrected claim | Verify correction instructions; do not substitute an appeal deadline |
| Reconsideration / appeal | Use the applicable denial or decision notice and the process below |
This registry has not established a payer-specific appeal ladder for Clover Health. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
Source: Clover Health provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with Clover Health
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
CMS-0057-F decision-timeframe requirements and exclusions
Verify Clover Health electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable. Authorization requirements and submission channels depend on the product, service and delegated reviewer. Verify the applicable policy before scheduling; a portal listing is not proof of X12 278 connectivity.
This registry does not provide a current prior-authorization code list for Clover Health. Start with the provider resources or the policy documents below, then confirm the applicable product, service and effective date. A resource link does not establish that a live code-lookup tool is available.
Top denial reasons for Clover Health
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient Clover Health volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Registry indication — not verification | Routing reference |
|---|---|---|
| 837P / 837I claims | Listed in registry; verify current scope | Clover lists current claims ID 13285 for named clearinghouses with Smart Data Solutions arrangements. Confirm the listed clearinghouse or its SDS arrangement; this is not a universal transaction identifier. |
| 270 / 271 eligibility | Listed in registry; verify current scope | Stored eligibility references remain unverified for the current product and transaction. A claims identifier must not be reused for 270/271 routing. |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | 77023 — registry reference; verify the member product, transaction and clearinghouse. Not verified: Stored ERA references remain unverified for the current product, clearinghouse and enrollment. This claims comparison does not establish an 835 identifier. |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
Source checks and remaining limits
The latest partial comparison is dated . Retained earlier findings keep their original dates below. This is a partial source check, not a whole-page, clinical or legal review. It does not refresh the legacy review date above.
Clearinghouse-specific claims and member contact
Source comparison: 2026-09-26
The claims page lists 13285 for named clearinghouses/SDS arrangements; the universal 77023 claims scalar is withdrawn. The stored phone is member services. Eligibility, ERA and filing remain unresolved.
Primary source for clearinghouse-specific claims and member contact
Not checked in this pass: Whole-record approval, legal identity and all ownership relationships; Product-specific filing and appeal rules beyond the stated findings; Transaction-specific eligibility/ERA IDs and live electronic capabilities; Authenticated access, QuickIntell integrations and outcomes.
Sources used for this guide
State coverage
Clover Health operates in the following states. Each link opens state-level Medicaid program details, dominant commercial payers, and state-specific RCM regulations.
Evaluate QuickIntell workflow fit for Clover Health
These module references are evaluation starting points, not evidence of a validated connection, supported transaction or customer deployment. Confirm the actual member plan, data access and product scope first.
- QuickRCM
Evaluate claim preparation, follow-up and denial worklists for Clover Health; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for Clover Health; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for Clover Health before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about Clover Health
Where is the Clover Health provider portal?
Use https://www.cloverhealth.com/en/providers as a starting point for Clover Health provider resources. This link may open a directory or contact page rather than a transaction portal. Select the applicable product and administrator, then verify the available functions, enrollment and access requirements. QuickIntell is not the official payer portal.
What is the timely filing limit for Clover Health?
This registry lists 365 days as an initial-claim reference for Clover Health. Confirm the applicable product, provider agreement, start event and current payer instructions. Do not apply this value automatically to out-of-network, secondary, corrected or appealed claims.
Does Clover Health publish a single claims payer ID?
This registry has not established one all-product claims payer ID for Clover Health. Claims: Clover lists current claims ID 13285 for named clearinghouses with Smart Data Solutions arrangements. Confirm the listed clearinghouse or its SDS arrangement; this is not a universal transaction identifier.. Eligibility (270/271): Stored eligibility references remain unverified for the current product and transaction. A claims identifier must not be reused for 270/271 routing.. ERA (835): 77023 — registry reference; verify the member product, transaction and clearinghouse. Not verified: Stored ERA references remain unverified for the current product, clearinghouse and enrollment. This claims comparison does not establish an 835 identifier.. Do not substitute a claims ID for an unverified transaction ID. Look up the correct ID for the member's plan and transaction in your clearinghouse directory and verify against the member ID card before submission.
Does Clover Health accept electronic claims?
Verify Clover Health electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable.
How do I appeal a Clover Health denial?
This registry has not established a payer-specific appeal ladder for Clover Health. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
How long do Clover Health prior authorization approvals take?
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
What is the Clover Health provider phone number?
This registry lists 1-888-778-1478 as a contact reference for Clover Health. 1-888-778-1478 is labelled member services. A provider-support replacement was not verified in this comparison.
Automate workflows around Clover Health requirements
Connect eligibility, prior authorization, pre-submission claim checks, and remittance routing in one governed workflow. Payer and plan configuration is confirmed during implementation.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against Clover Health's current published documents before submission. CPT® is a registered trademark of the American Medical Association.