MedRisk provider portal, phone and payer ID quick facts
| Provider portal | https://www.medrisk.com |
|---|---|
| Provider phone | 1-800-225-9675 |
| Claims payer ID | Verify in clearinghouse payer list |
| Eligibility payer ID | Verify in clearinghouse payer list |
| ERA payer ID | Clearinghouse-specific |
| Timely filing | 90 days |
| Prior auth route | Provider portal or policy document |
| Last reviewed | 2026-04-23 |
- MedRisk does not expose one verified national ERA payer ID in this registry. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment.
MedRisk at a glance
| Legal name | MedRisk, Inc. |
|---|---|
| Also known as | MedRisk PT Network |
| Category | Third-party administrator (TPA) |
| Parent organization | CVC Capital Partners |
| Claims payer ID | Not published |
| Eligibility (270/271) payer ID | Not published |
| ERA (835) payer ID | Clearinghouse-specific |
| NAIC company code | Not published |
| States covered | Nationwide (50 states) |
| Provider portal | https://www.medrisk.com |
| Provider phone | 1-800-225-9675 |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for MedRisk
MedRisk's standard timely filing window for participating providers is 90 days from the date of service. Plan-specific products (Medicare Advantage, Medicaid, employer groups, secondary claims) may have shorter or longer windows — always confirm against the policy linked below before disputing a TFL denial.
| Submission type | Window |
|---|---|
| In-network initial claim | 90 days |
| Out-of-network initial claim | 90 days (verify per plan) |
| Secondary / coordination of benefits | 90 days from primary EOB |
| Corrected / appeal | 90 days from denial |
Appeal levels
- Level 1: First-Level ReconsiderationFile within 90 days
Written request for claim reconsideration with supporting documentation, filed within the stated window of the denial notification.
- Level 2: Second-Level Formal AppealFile within 60 days
Formal appeal reviewed by a party not involved in the initial determination; typically requires the first-level decision letter.
- Level 3: External / Independent ReviewFile within 120 days
External Independent Review Organization (IRO) review per ACA §2719 and applicable state law.
Source: MedRisk provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with MedRisk
MedRisk does not currently accept X12 278 prior-authorization transactions; submit via portal or fax. 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.
MedRisk 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 MedRisk
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient MedRisk 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 | — |
| 270 / 271 eligibility | No | — |
| 278 prior authorization | No | — |
| 835 ERA | No | Clearinghouse-specific |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
QuickIntell coverage for MedRisk
Frequently asked questions about MedRisk
Where is the MedRisk provider portal?
The MedRisk provider portal is available at https://www.medrisk.com. 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 MedRisk?
MedRisk's standard timely filing limit for participating providers is 90 days from the date of service. Plan-specific products (Medicare Advantage, Medicaid managed care, employer groups) may have different windows — confirm against the payer's provider manual before disputing a TFL denial.
Does MedRisk publish a single claims payer ID?
MedRisk does not publish a single canonical claims payer ID — routing is plan- or jurisdiction-specific. Look up the correct ID per member in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and verify against the member ID card before submission.
Does MedRisk accept electronic claims?
Yes — MedRisk accepts ANSI X12 837P and 837I electronic claims through standard clearinghouses. Real-time eligibility (270/271) is not currently supported and X12 278 prior authorization is not currently supported.
How do I appeal a MedRisk denial?
MedRisk uses a 3-level appeal process. Level 1 (First-Level Reconsideration) must be filed within 90 days of the denial. Each escalation level requires the prior decision letter and supporting clinical or coding documentation. See the appeal-levels block above for deadlines and process.
How long do MedRisk prior authorization approvals take?
MedRisk's prior-authorization decision turnaround typically follows standard industry windows: 72 hours for urgent requests and up to 14 calendar days for non-urgent requests. Specialty drugs and high-cost imaging may extend further. Submit through the MedRisk provider portal for the fastest turnaround.
What is the MedRisk provider phone number?
Providers can reach MedRisk at 1-800-225-9675 for claims status, eligibility verification, and authorization questions. Have the member ID, date of service, and tax ID ready before calling. Most operational tasks are faster through the provider portal at https://www.medrisk.com.
Run cleaner claims to MedRisk with QuickIntell
QuickAuth, QuickRCM, and QuickERA are validated against MedRisk's EDI behavior — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules.
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 MedRisk's current published documents before submission. CPT® is a registered trademark of the American Medical Association.