Sentara Health Plans provider portal, phone and payer ID quick facts
| Provider portal | https://www.sentarahealthplans.com/providers |
|---|---|
| Provider phone | 1-800-543-3359 |
| Claims payer ID | Verify in clearinghouse payer list |
| Eligibility payer ID | Not established in this registry; verify with clearinghouse |
| ERA payer ID | Clearinghouse-specific |
| Timely filing | 180 days (verify applicability) |
| Prior auth route | X12 278 plus provider portal |
| Last reviewed | 2026-04-23 |
- 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.
- 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.
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 | Not established in this registry |
| Eligibility (270/271) payer ID | Not established in this registry |
| ERA (835) payer ID | Clearinghouse-specific |
| NAIC company code | Not established in this registry |
| States covered | Virginia |
| Provider portal | https://www.sentarahealthplans.com/providers |
| Provider phone | 1-800-543-3359 |
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
Sentara Health Plans accepts X12 278 prior-authorization transactions electronically. 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.
Sentara Health Plans 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 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 | Supported | Payer ID |
|---|---|---|
| 837P / 837I claims | Yes | — |
| 270 / 271 eligibility | Yes | — |
| 278 prior authorization | Yes | Verify X12 278 routing separately |
| 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.
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.
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.
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.
QuickIntell coverage for Sentara Health Plans
- QuickRCM
End-to-end claim lifecycle automation tuned to Sentara Health Plans's edits and adjudication patterns.
- QuickAuth
Automated prior-authorization submissions and status checks for Sentara Health Plans services that require PA.
- QuickERA
Automated 835 ERA posting from Sentara Health Plans with payment reconciliation and denial routing.
Frequently asked questions about Sentara Health Plans
Where is the Sentara Health Plans provider portal?
The Sentara Health Plans provider portal is available at https://www.sentarahealthplans.com/providers. 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 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 claims payer ID for Sentara Health Plans. 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?
Yes — Sentara Health Plans accepts ANSI X12 837P and 837I electronic claims through standard clearinghouses. Real-time eligibility (270/271) is supported and X12 278 prior authorization is supported.
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 1-800-543-3359 as a provider contact for Sentara Health Plans. Confirm the service scope and the number on the member ID card; claim, eligibility and authorization inquiries may use different teams. Have the member ID, date of service and tax ID ready. The provider portal is https://www.sentarahealthplans.com/providers.
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.