MetroPlus Health provider portal, phone and payer ID quick facts
| Provider resource entry point | https://metroplus.org/providers/claims/ |
|---|---|
| Payer contact reference | 1-800-303-9626Current page lists 800-303-9626 for Provider Services and claims status. |
| Claims payer ID | MetroPlus’s public claims page identifies 13265 for electronic claims through Emdeon. Confirm the product and clearinghouse; this claims reference does not independently verify eligibility or ERA routing. |
| Eligibility payer ID | Stored eligibility references remain unverified for the current product and transaction. Claims identifiers do not establish 270/271 routing. |
| ERA payer ID | 13265 — 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. |
| Timely filing | Initial claims: 90 days from service or discharge; verify scope |
| 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 |
- Current page lists 800-303-9626 for Provider Services and claims status.
- MetroPlus’s current public claims page states initial submission within 90 days of service or discharge. The page does not establish every product’s participating/nonparticipating applicability or all exceptions. Verify the controlling product manual and provider agreement; do not apply this as a universal all-plan scalar.
- This registry has not established a payer-specific appeal ladder for MetroPlus 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.
- Stored ERA references remain unverified for the current product, clearinghouse and enrollment. This claims comparison does not establish an 835 identifier.
MetroPlus Health at a glance
| Legal name | MetroPlus Health Plan, Inc. |
|---|---|
| Also known as | MetroPlus, NYC MetroPlus |
| Category | Medicaid MCO |
| Parent organization | NYC Health + Hospitals (public) |
| Claims payer ID | MetroPlus’s public claims page identifies 13265 for electronic claims through Emdeon. Confirm the product and clearinghouse; this claims reference does not independently verify eligibility or ERA routing. |
| Eligibility (270/271) payer ID | Stored eligibility references remain unverified for the current product and transaction. Claims identifiers do not establish 270/271 routing. |
| ERA (835) payer ID | 13265 — 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 York |
| Members covered | ~700k members |
| Provider resource entry point | https://metroplus.org/providers/claims/ |
| Provider phone | 1-800-303-9626Current page lists 800-303-9626 for Provider Services and claims status. |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for MetroPlus Health
MetroPlus’s current public claims page states initial submission within 90 days of service or discharge. The page does not establish every product’s participating/nonparticipating applicability or all exceptions. Verify the controlling product manual and provider agreement; do not apply this as a universal all-plan scalar.
| Submission type | Window |
|---|---|
| Initial claim reference | Initial claims: 90 days from service or discharge; verify scope |
| 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 MetroPlus 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: MetroPlus Health provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with MetroPlus 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 MetroPlus 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 MetroPlus 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 MetroPlus Health
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient MetroPlus 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 | MetroPlus’s public claims page identifies 13265 for electronic claims through Emdeon. Confirm the product and clearinghouse; this claims reference does not independently verify eligibility or ERA routing. |
| 270 / 271 eligibility | Listed in registry; verify current scope | Stored eligibility references remain unverified for the current product and transaction. Claims identifiers do not establish 270/271 routing. |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | 13265 — 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.
timely_filing_days
Source comparison: 2026-09-26
Current claims page says initial submission within 90 days of service or discharge, rather than stored 120. It directs readers to the manual for complete reimbursement instructions.
Primary source for timely_filing_daysprovider_phone
Source comparison: 2026-09-26
Current page lists 800-303-9626 for Provider Services and claims status.
Primary source for provider_phonepayer_ids.claims
Source comparison: 2026-09-26
13265 is explicitly the Emdeon electronic claims ID; this does not independently verify eligibility or ERA IDs.
Primary source for payer_ids.claimsportal_url
Source comparison: 2026-09-26
Current claims-resource page links the official provider portal and submission instructions.
Primary source for portal_url
Not checked in this pass: Whole-record approval, legal identity, ownership and complete product coverage; Authenticated transactions and QuickIntell integrations; payer_ids.eligibility / payer_ids.era / era_payer_id: No transaction-specific universal eligibility/ERA identifier established; do not copy a claims ID.; electronic_claims_supported / supports_279_271 / supports_278: No blanket transaction-capability or QuickIntell connectivity certification; unauthenticated resources do not establish all stored flags.; appeal_levels / prior_auth_required_codes_sample / qi_module_coverage: No new approval of appeals, code-specific authorization or product integrations in this bounded pass..
Sources used for this guide
State coverage
MetroPlus 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 MetroPlus 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 MetroPlus Health; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for MetroPlus Health; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for MetroPlus Health before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about MetroPlus Health
Where is the MetroPlus Health provider portal?
Use https://metroplus.org/providers/claims/ as a starting point for MetroPlus 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 MetroPlus Health?
MetroPlus’s current public claims page states initial submission within 90 days of service or discharge. The page does not establish every product’s participating/nonparticipating applicability or all exceptions. Verify the controlling product manual and provider agreement; do not apply this as a universal all-plan scalar.
Does MetroPlus Health publish a single claims payer ID?
This registry has not established one all-product claims payer ID for MetroPlus Health. Claims: MetroPlus’s public claims page identifies 13265 for electronic claims through Emdeon. Confirm the product and clearinghouse; this claims reference does not independently verify eligibility or ERA routing.. Eligibility (270/271): Stored eligibility references remain unverified for the current product and transaction. Claims identifiers do not establish 270/271 routing.. ERA (835): 13265 — 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 MetroPlus Health accept electronic claims?
Verify MetroPlus 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 MetroPlus Health denial?
This registry has not established a payer-specific appeal ladder for MetroPlus 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 MetroPlus 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 MetroPlus Health provider phone number?
This registry lists 1-800-303-9626 as a contact reference for MetroPlus Health. Current page lists 800-303-9626 for Provider Services and claims status.
Automate workflows around MetroPlus 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 MetroPlus Health's current published documents before submission. CPT® is a registered trademark of the American Medical Association.