Providence Health Plan provider portal, phone and payer ID quick facts
| Provider resource entry point | https://www.providencehealthplan.com/providers |
|---|---|
| Payer contact reference | 1-503-574-7500General Customer Service |
| Claims payer ID | Providence lists SX133 for 837/835 through Optum and SSI, and PHP01 for 837/835 through Office Ally and TriZetto. VisibilEDI PHP01 is listed for 837 only. Confirm the exact vendor and transaction; the table does not support one universal 93029 identifier. |
| 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 | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: The vendor table lists 835 support with SX133 through Optum/SSI and PHP01 through Office Ally/TriZetto; VisibilEDI PHP01 is listed for 837 only. Clearinghouses arrange 835 enrollment with Providence. These instructions do not establish eligibility routing or a universal ERA scalar. |
| 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 |
- General Customer Service
- This registry has not established a payer-specific appeal ladder for Providence Health Plan. 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.
- The vendor table lists 835 support with SX133 through Optum/SSI and PHP01 through Office Ally/TriZetto; VisibilEDI PHP01 is listed for 837 only. Clearinghouses arrange 835 enrollment with Providence. These instructions do not establish eligibility routing or a universal ERA scalar.
Providence Health Plan at a glance
| Legal name | Providence Health Plan |
|---|---|
| Also known as | Providence Health Assurance |
| Category | Commercial |
| Parent organization | Providence St. Joseph Health |
| Claims payer ID | Providence lists SX133 for 837/835 through Optum and SSI, and PHP01 for 837/835 through Office Ally and TriZetto. VisibilEDI PHP01 is listed for 837 only. Confirm the exact vendor and transaction; the table does not support one universal 93029 identifier. |
| 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 | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: The vendor table lists 835 support with SX133 through Optum/SSI and PHP01 through Office Ally/TriZetto; VisibilEDI PHP01 is listed for 837 only. Clearinghouses arrange 835 enrollment with Providence. These instructions do not establish eligibility routing or a universal ERA scalar. |
| NAIC company code | Not established in this registry |
| States covered | Oregon, Washington |
| Members covered | ~600k members |
| Provider resource entry point | https://www.providencehealthplan.com/providers |
| Provider phone | 1-503-574-7500General Customer Service |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for Providence Health Plan
This registry lists 90 days as an initial-claim reference for Providence Health Plan. 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 Providence Health Plan. 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: Providence Health Plan provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with Providence Health Plan
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 Providence Health Plan 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 Providence Health Plan. 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 Providence Health Plan
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient Providence Health Plan 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 | Providence lists SX133 for 837/835 through Optum and SSI, and PHP01 for 837/835 through Office Ally and TriZetto. VisibilEDI PHP01 is listed for 837 only. Confirm the exact vendor and transaction; the table does not support one universal 93029 identifier. |
| 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 | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: The vendor table lists 835 support with SX133 through Optum/SSI and PHP01 through Office Ally/TriZetto; VisibilEDI PHP01 is listed for 837 only. Clearinghouses arrange 835 enrollment with Providence. These instructions do not establish eligibility routing or a universal ERA scalar. |
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
The current provider resource is hosted on providencehealthplan.com and links ProvLink and electronic-claims guidance.
Primary source for portal_urlprovider_phone
Source comparison: 2026-09-26
503-574-7500 is published for general/criteria questions and Customer Service, with toll-free 800-878-4445; specialized relations and policy teams remain separate.
Primary source for provider_phonepayer_ids.claims / payer_ids.era / era_payer_id
Source comparison: 2026-09-26
The current vendor table lists SX133 for 837/835 through Optum and SSI; PHP01 for 837/835 through Office Ally and TriZetto; VisibilEDI PHP01 is listed for 837 only. Stored universal 93029 is not supported by this table.
Primary source for payer_ids.claims / payer_ids.era / era_payer_idpayment_workflow
Source comparison: 2026-09-26
Zelis handles payment functions; clearinghouses arrange 835 enrollment with Providence. Public instructions do not prove a QuickIntell integration.
Primary source for payment_workflow
Not checked in this pass: Whole-record approval, legal identity, ownership and complete product coverage; Authenticated transactions and QuickIntell integrations; timely_filing_days: No universal filing scalar established; verify the controlling plan, contract, jurisdiction and start event.; 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
Providence Health Plan 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 Providence Health Plan
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 Providence Health Plan; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for Providence Health Plan; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for Providence Health Plan before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about Providence Health Plan
Where is the Providence Health Plan provider portal?
Use https://www.providencehealthplan.com/providers as a starting point for Providence Health Plan 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 Providence Health Plan?
This registry lists 90 days as an initial-claim reference for Providence Health Plan. 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 Providence Health Plan publish a single claims payer ID?
This registry has not established one all-product claims payer ID for Providence Health Plan. Claims: Providence lists SX133 for 837/835 through Optum and SSI, and PHP01 for 837/835 through Office Ally and TriZetto. VisibilEDI PHP01 is listed for 837 only. Confirm the exact vendor and transaction; the table does not support one universal 93029 identifier.. Eligibility (270/271): Stored eligibility references remain unverified for the current product and transaction. Claims identifiers do not establish 270/271 routing.. ERA (835): No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: The vendor table lists 835 support with SX133 through Optum/SSI and PHP01 through Office Ally/TriZetto; VisibilEDI PHP01 is listed for 837 only. Clearinghouses arrange 835 enrollment with Providence. These instructions do not establish eligibility routing or a universal ERA scalar.. 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 Providence Health Plan accept electronic claims?
Verify Providence Health Plan 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 Providence Health Plan denial?
This registry has not established a payer-specific appeal ladder for Providence Health Plan. 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 Providence Health Plan 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 Providence Health Plan provider phone number?
This registry lists 1-503-574-7500 as a contact reference for Providence Health Plan. General Customer Service
Automate workflows around Providence Health Plan 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 Providence Health Plan's current published documents before submission. CPT® is a registered trademark of the American Medical Association.