The following resources are available to help you work with Aspirus Health Plan Medicare Advantage members.
For first time claim submission, please review the Claims & Billing webpage and the Aspirus Health Plan Medicare Advantage Provider Manual (PDF). These resources include information on billing, remittances, taxonomy, forms, links and more.
Aspirus Health Plan encourages the submission of Medical Claims electronically. Guidance for electronic claims submission is provided in the Electronic Data Interchange chapter of the Aspirus Health Plan Medicare Advantage Provider Manual (PDF).
A clearinghouse allows you to submit secure claims electronically. They scrub the claim for errors, then securely transmit the electronic claim to the insurance payer.
Aspirus Health Plan’s electronic claims transactions are accessible through our trading partner: Change Healthcare. Providers must contact Change Healthcare directly to enroll in available electronic transactions.
For more information visit the Claims & Billing webpage. If you have questions about EDI transactions, please email EDISupportMA@aspirushealthplan.com.
Click here to download a printable W-9 (PDF).
Aspirus Health Plan requires the corresponding taxonomy to be submitted whenever a National Provider Identification (NPI) is reported on a claim submitted directly to Aspirus Health Plan or on claims that will crossover and be coordinated with Aspirus Health Plan coverage. When taxonomy is not reported on a claim that includes a NPI number(s), the claim will be rejected.
This process does not add your organization to Aspirus Health Plan ‘s contracted provider network. Please see the Our Network webpage if interested in becoming an Aspirus Health Plan contracted provider.
When submitting claims follow the Centers for Medicare & Medicaid Services (CMS) and standard billing guidelines. Aspirus Health Plan reimbursement will be based on CMS guidelines, Federal and State regulatory requirements.
Resources and forms for Claims Reconsideration are available on the Claims & Billing webpage under Forms & Links.
For detailed guidance see the Aspirus Health Plan Medicare Advantage Provider Manual (PDF), go to the Claims & Payment chapter and review the Non-Contracted Provider Appeal Process section.
You must have access to the Aspirus Health Plan Provider Portal to request Electronic Payment and Remittance from UCare. Provider Portal access also allows you to check member eligibility and view claims, EOPs and authorizations.
If you contract with a third-party biller to call Aspirus Health Plan on your behalf, we need a signed acknowledgement form on file giving Aspirus Health Plan permission to release information. Click the link below to approve a third-party biller.
Provider Notification/Change/Update/Termination Third-Party Agreement (PDF)
Authorization grids, resources and forms for Aspirus Health Plan’s Medicare Advantage plans.
The Aspirus Health Plan Provider Portal is a secure website that allows your organization to access information needed to work with Aspirus Health Plan members. You can check member eligibility and view claims, EOPs and authorizations. You must be enrolled in the Aspirus Health Plan Claim Payment System to be granted access to the Aspirus Health Plan Provider Portal.
Visit the Pharmacy webpage for the following:
• Drug coverage information by plan
• Medical injectable drug prior authorization information by plan
• Formulary information by plan
• Forms to request exceptions or authorizations
Learn more about Real-time Part D Vaccine claims using TransactRX (PDF).
Ensure that Aspirus Health Plan has accurate information for your organization, location and service providers.
