Essence Healthcare provider portal, phone and payer ID quick facts
| Provider portal | https://www.essencehealthcare.com/providers |
|---|---|
| Provider phone | 1-866-597-9560 |
| Claims payer ID | 20818 |
| Eligibility payer ID | 20818 |
| ERA payer ID | 20818 |
| Timely filing | 90 days (verify applicability) |
| Prior auth route | X12 278 plus provider portal |
| Last reviewed | 2026-04-23 |
- This registry has not established a payer-specific appeal ladder for Essence Healthcare. 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.
Essence Healthcare at a glance
| Legal name | Essence Healthcare |
|---|---|
| Also known as | Essence MA |
| Category | Medicare Advantage |
| Parent organization | Essence Group Holdings |
| Claims payer ID | 20818 |
| Eligibility (270/271) payer ID | 20818 |
| ERA (835) payer ID | 20818 |
| NAIC company code | Not established in this registry |
| States covered | Missouri, Illinois, Indiana, Arizona, North Carolina |
| Members covered | ~110k members |
| Provider portal | https://www.essencehealthcare.com/providers |
| Provider phone | 1-866-597-9560 |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for Essence Healthcare
This registry lists 90 days as an initial-claim reference for Essence Healthcare. 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 | 90 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 Essence Healthcare. 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: Essence Healthcare provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with Essence Healthcare
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
Essence Healthcare accepts X12 278 prior-authorization transactions electronically. The procedures most commonly subject to prior authorization include advanced imaging, inpatient admissions, specialty pharmacy, and certain outpatient surgical procedures. Use the payer's authorization tool below to confirm requirements per CPT before scheduling a service.
Essence Healthcare maintains a live prior-authorization code lookup tool that supersedes any cached list. Use the provider portal or the policy documents below to confirm the current PA list before rendering a service.
Top denial reasons for Essence Healthcare
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient Essence Healthcare volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Supported | Payer ID |
|---|---|---|
| 837P / 837I claims | Yes | 20818 |
| 270 / 271 eligibility | Yes | 20818 |
| 278 prior authorization | Yes | Verify X12 278 routing separately |
| 835 ERA | Yes | 20818 |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
State coverage
Essence Healthcare operates in the following states. Each link opens state-level Medicaid program details, dominant commercial payers, and state-specific RCM regulations.
QuickIntell coverage for Essence Healthcare
- QuickRCM
End-to-end claim lifecycle automation tuned to Essence Healthcare's edits and adjudication patterns.
- QuickAuth
Automated prior-authorization submissions and status checks for Essence Healthcare services that require PA.
- QuickERA
Automated 835 ERA posting from Essence Healthcare with payment reconciliation and denial routing.
Frequently asked questions about Essence Healthcare
Where is the Essence Healthcare provider portal?
The Essence Healthcare provider portal is available at https://www.essencehealthcare.com/providers. Use it for eligibility checks, claim status, prior authorization workflows, appeals, and payer-specific routing updates. QuickIntell links to the payer's provider-facing portal as a reference and is not the official payer portal.
What is the timely filing limit for Essence Healthcare?
This registry lists 90 days as an initial-claim reference for Essence Healthcare. 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.
What is the Essence Healthcare payer ID?
The registry lists claims payer ID 20818 for Essence Healthcare. Eligibility (270/271): 20818. ERA (835): 20818. Do not substitute a claims ID for an unverified transaction ID. Confirm the member ID card, product and clearinghouse payer list before submitting.
Does Essence Healthcare accept electronic claims?
Yes — Essence Healthcare accepts ANSI X12 837P and 837I electronic claims through standard clearinghouses. Real-time eligibility (270/271) is supported and X12 278 prior authorization is supported.
How do I appeal a Essence Healthcare denial?
This registry has not established a payer-specific appeal ladder for Essence Healthcare. 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 Essence Healthcare 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 Essence Healthcare provider phone number?
This registry lists 1-866-597-9560 as a provider contact for Essence Healthcare. Confirm the service scope and the number on the member ID card; claim, eligibility and authorization inquiries may use different teams. Have the member ID, date of service and tax ID ready. The provider portal is https://www.essencehealthcare.com/providers.
Automate workflows around Essence Healthcare 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 Essence Healthcare's current published documents before submission. CPT® is a registered trademark of the American Medical Association.