Essence Healthcare provider portal, phone and payer ID quick facts
| Provider resource entry point | https://provider.essencehealthcare.com/ |
|---|---|
| Payer contact reference | 1-866-597-9560 |
| Claims payer ID | 20818 — registry reference; verify the member product, transaction and clearinghouse |
| Eligibility payer ID | 20818 — registry reference; verify the member product, transaction and clearinghouse |
| ERA payer ID | 20818 — registry reference; verify the member product, transaction and clearinghouse |
| Timely filing | 90 days (verify applicability) |
| Prior auth route | Verify the current product policy and delegated reviewer; X12 278 support is not established by a portal link |
| 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 — registry reference; verify the member product, transaction and clearinghouse |
| Eligibility (270/271) payer ID | 20818 — registry reference; verify the member product, transaction and clearinghouse |
| ERA (835) payer ID | 20818 — registry reference; verify the member product, transaction and clearinghouse |
| NAIC company code | Not established in this registry |
| States covered | Missouri, Illinois, Indiana, Arizona, North Carolina |
| Members covered | ~110k members |
| Provider resource entry point | https://provider.essencehealthcare.com/ |
| 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
Verify Essence Healthcare 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 Essence Healthcare. 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 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 | Registry indication — not verification | Routing reference |
|---|---|---|
| 837P / 837I claims | Listed in registry; verify current scope | 20818 — registry reference; verify the member product, transaction and clearinghouse |
| 270 / 271 eligibility | Listed in registry; verify current scope | 20818 — registry reference; verify the member product, transaction and clearinghouse |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | 20818 — registry reference; verify the member product, transaction and clearinghouse |
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.
portal_url
Source comparison: 2026-09-26
Public provider resources link the current provider.essencehealthcare.com portal, with 2026 administrative materials behind login.
Primary source for portal_urlprovider_phone
Source comparison: 2026-09-26
The public provider login explicitly lists 866-597-9560 for health-plan claims, eligibility and patient-referral inquiries.
Primary source for provider_phone
Not checked in this pass: Whole-record approval, legal identity, ownership and complete product coverage; Authenticated transactions and QuickIntell integrations; timely_filing_days: Current 2026 administrative manuals require portal access. A2023 search-only manual does not validate or replace the stored 90-day number; no current numeric finding.; payer_ids.claims: The readable public sources do not verify stored 20818 for a particular clearinghouse/product.; record_scope: Not verified by the retrieved sources in this bounded comparison; retain explicit uncertainty and do not infer from another field or organization.; payer_ids.eligibility / payer_ids.era / era_payer_id: No current transaction-specific eligibility/ERA identifier evidence was verified; do not reuse claim identifiers.; electronic_claims_supported / supports_279_271 / supports_278: Not verified by the retrieved sources in this bounded comparison; retain explicit uncertainty and do not infer from another field or organization.; appeal_levels / prior_auth_required_codes_sample / qi_module_coverage: Not verified by the retrieved sources in this bounded comparison; retain explicit uncertainty and do not infer from another field or organization..
Sources used for this guide
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.
Evaluate QuickIntell workflow fit for Essence Healthcare
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 Essence Healthcare; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for Essence Healthcare; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for Essence Healthcare before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about Essence Healthcare
Where is the Essence Healthcare provider portal?
Use https://provider.essencehealthcare.com/ as a starting point for Essence Healthcare 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 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?
Claims: 20818 — registry reference; verify the member product, transaction and clearinghouse. Eligibility (270/271): 20818 — registry reference; verify the member product, transaction and clearinghouse. ERA (835): 20818 — registry reference; verify the member product, transaction and clearinghouse. Do not substitute a claims ID for an unverified transaction ID. Check current source findings and the member ID card before submitting.
Does Essence Healthcare accept electronic claims?
Verify Essence Healthcare 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 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 contact reference for Essence Healthcare. Confirm the number and service scope against the member ID card and current product-specific directory; claims, eligibility and authorization inquiries may use different teams.
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.