Sentara Health Plans at a glance
| Legal name | Sentara Health Plans |
|---|---|
| Also known as | Sentara, Optima Health, Virginia Premier |
| Category | Commercial |
| Parent organization | Sentara Healthcare |
| Claims payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| Eligibility (270/271) payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| 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: This registry has not established one national ERA payer ID for Sentara Health Plans. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
| NAIC company code | Not established in this registry |
| States covered | Virginia |
| Provider resource entry point | https://www.sentara.com/en/health-plans/providers/provider-portals |
| Provider phone | 1-800-229-8822Medical/Medicaid provider services; behavioral health: 800-648-8420. |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for Sentara Health Plans
This registry lists 180 days as an initial-claim reference for Sentara Health Plans. 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 | 180 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 Sentara Health Plans. 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: Sentara Health Plans provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with Sentara Health Plans
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 Sentara Health Plans 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 Sentara Health Plans. 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 Sentara Health Plans
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient Sentara Health Plans 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 | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| 270 / 271 eligibility | Listed in registry; verify current scope | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| 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: This registry has not established one national ERA payer ID for Sentara Health Plans. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
What revenue cycle teams should verify before submitting claims
- Treat Sentara, Optima Health, and Virginia Premier naming as a single source-check problem: verify the member product and provider portal before selecting a claim route.
- Do not configure a national payer ID from this generic record; confirm the current payer ID in Availity, Change Healthcare/Optum, Waystar, or the provider's clearinghouse.
- For Virginia Medicaid or marketplace products, confirm whether claim routing, authorization, and appeal rules follow the member's product line rather than the legacy brand name.
- Use the current portal feature matrix. September 2026 expansion and later planned functionality have separate availability dates; future claim tools must not be treated as active.
Common denial and routing risks for this payer
- Submitting under a legacy Optima Health or Virginia Premier route when the member card points to Sentara Health Plans.
- Using a clearinghouse payer ID from another Sentara product without validating the product line.
- Missing authorization requirements because the request was checked under the wrong portal or plan name.
How QuickIntell supports this workflow
- Capture member-card product name, portal result, and clearinghouse payer ID confirmation before first claim release.
- Map legacy Optima/Virginia Premier aliases to the active Sentara workqueue for eligibility and authorization follow-up.
- Hold claims with blank or ambiguous payer IDs for routing verification instead of allowing generic submission.
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
Current portal matrix directs claim submission/status, eligibility and remittances to Availity; the legacy portal has separate authorization-transition roles.
Primary source for portal_urlprovider_phone
Source comparison: 2026-09-26
Medical provider services publishes 800-229-8822; behavioral health uses 800-648-8420. Baseline 800-543-3359 is not corroborated as provider services.
Primary source for provider_phoneelectronic_claims_supported
Source comparison: 2026-09-26
The payer documents Availity claim submission and an EDI team for the 837 process.
Primary source for electronic_claims_supportedrecord_scope
Source comparison: 2026-09-26
September 21 2026 portal expansion has phased future functions; projected Q4 2026/Q1 2027 claim tools must not be described as already available.
Primary source for record_scope
Not checked in this pass: Whole-record approval, legal identity, ownership and complete product coverage; Authenticated transactions and QuickIntell integrations; timely_filing_days / payer_ids / supports_279_271 / supports_278: The inspected pages do not establish universal 180-day filing, transaction IDs, or X12 eligibility/278 capabilities. Portal features alone are insufficient..
Sources used for this guide
State coverage
Sentara Health Plans 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 Sentara Health Plans
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 Sentara Health Plans; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for Sentara Health Plans; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for Sentara Health Plans before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about Sentara Health Plans
Where is the Sentara Health Plans provider portal?
Use https://www.sentara.com/en/health-plans/providers/provider-portals as a starting point for Sentara Health Plans 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 Sentara Health Plans?
This registry lists 180 days as an initial-claim reference for Sentara Health Plans. 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 Sentara Health Plans publish a single claims payer ID?
This registry has not established one all-product claims payer ID for Sentara Health Plans. See the source findings for transaction-specific references. 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 Sentara Health Plans accept electronic claims?
Verify Sentara Health Plans 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 Sentara Health Plans denial?
This registry has not established a payer-specific appeal ladder for Sentara Health Plans. 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 Sentara Health Plans 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 Sentara Health Plans provider phone number?
This registry lists 1-800-229-8822 as a contact reference for Sentara Health Plans. Medical/Medicaid provider services; behavioral health: 800-648-8420.
Automate workflows around Sentara Health Plans 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 Sentara Health Plans's current published documents before submission. CPT® is a registered trademark of the American Medical Association.