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FAQ & Reference Guide

For additional questions or assistance from the Network Development and Provider Relations team, please visit the Provider Assistance page and complete a Provider Ticket Submission Form.

Frequently Asked Questions

Who is HealthSmart?

HealthSmartis PHP’s Third-Party Administrator (TPA). HealthSmart provides various management services for Partners Health Plan (PHP) including, but not limited to, claims processing.

What are my options for submitting claims to PHP:

See our Billing and Claims page for claims submission information and guidelines.

What is PHP’s EDI submitter number? Is it the same for both clearinghouse options?

14966 - Yes, it isthe same submitter ID value regardless ofsubmission to the Change HealthCare (formerly Emdeon) or HealthSmart Clearinghouse

Can I submit claims through the provider portal?

Yes.

  • Web-based Claims Submission:

    Providers can now easily create and upload a professional or institutional single claim as a pdf file via the provider portal (php.healthsmart.com). 

    • Web-based claims are considered paper claims and will follow all existing claim submission protocols.
    • Please note that only valid claim forms (CMS 1500 or UB 04) may be uploaded using this method.

See our Billing and Claims page for other claims submission options, information, and guidelines.

Is there a charge for submitting claims directly to the HealthSmart Clearinghouse?

No, there is no charge to PHP providers to submit PHP claims directly to the HealthSmart Clearinghouse.

Who should I contact if I am interested in submitting EDI claims to the HealthSmart Clearinghouse?

Contact HealthSmart EDI Support at 1-888-744-6638. You will have to complete an EDI enrollment form, as well as, a User License Agreement to begin the submission process.

How often are PHP’s check runs?

PHP typically generates two check runs per week.

What forms of payments are offered?

See the ECHO Payment & Remits FAQ document.

Why is my claim denying with a Remark Code ‘PA’?

This code identifies that you have submitted a procedure code which requires the NDC Code, Qualifier, and Units for which you did notsubmit any or all these data elements on your claim submission.

Why did I receive a Claim Adjustment Reason Code 252 (an attachment/other documentation is required to adjudicate this claim/service) and Remittance Advice Remark Code M119 on my 835 Claim Payment/Advice?

Thisidentifies that you have submitted a procedure code which requires the NDC Code, Qualifier, and Units for which you did not submit any or all these data elements on your claim submission.

Why did I receive a Claim Adjustment Reason Code 252 (an attachment/other documentation is required to adjudicate this claim/service) and Remittance Advice Remark Code M119 on my 835 Claim Payment/Advice?

Thisidentifies that you have submitted a procedure code which requires the NDC Code, Qualifier, and Units for which you did not submit any or all these data elements on your claim submission.

Why is a National Drug Code (NDC) required?

New York State Department of Health (NYSDOH) mandatesthat all Managed Care Plans must report National Drug Codes (NDCs) for all physician-administered drugs.

Which procedure codes require NDC information be reported?

All physician-administered drugs, by all provider types, require a valid 11-digit NDC number and the applicable quantity and measurement. This includes all J-codes and all other applicable drug codes (i.e., chemotherapeutics, therapeutics, etc.).

How do I submit the required NDC information on an 837 electronic claim submission?

In either the 837I or 837P format providers must report the 11-digit NDC and its corresponding information, in addition to the procedure code, in the LIN segment of Loop ID 2410 to specify the physician-administered drug that is part of the service described in SV1 forthe 837 format. Providers must also report the quantity and unit of measure of the NDC as outlined in the table below:

Where do I enter the required NDC information if I am submitting a paper claim?
  • CMS-1500 Box 24A example: NDC qualifier (N4) + NDC (11-digits) + unit of measurement qualifier (UN) + unit quantity (1)
  • UB04 FL 43 example: NDC qualifier (N4) + NDC (11-digits) + unit of measurement qualifier UN) + unit quantity (1)

*The following are the only acceptable values forsubmission as a Unit of Measurement Qualifier: • GR (gram) • ML (milliliter) • ME (milligram) • UN (unit) • F2 (international unit)

How do I resubmit my claim if I received a denial for missing/invalid NDC information?

On an Institutional UB-04 claim you should submit as a corrected claim, which is identified by utilizing the applicable Bill Type ending in ‘7’ to designate as corrected (i.e., XX7, 137, 737, etc.)

On a Professional CMS-1500 claim you should mark the claim as corrected and include the original claim number in Box 22 ‘Original Reference No.’.

All resubmissions/corrected claimsshould include all original claim lines, not just the correction to the physician-administered drug claim lin

Quick Reference Guide

Need Provider Assistance?

The Partners Health Plan Network Development and Provider Relations team is here to assist you with your billing, claims, authorization, education, and any other general inquiry. Use the Contact Us button below to complete a Provider Ticket Submission Form.

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Contact Us
  • Partners Health Plan
  • 2500 Halsey Street
    Bronx, NY 10461
  • (855) PHP-LIVE or (855) 747-5483
  • TTY:711
  • 8am-8pm, 7 days a week

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855-747-5483 | TTY/TDD:711
Partners Health Plan is a managed care plan that contracts with Medicare and the New York State Department of Health (Medicaid) to provide benefits to Participants through the Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) Demonstration.

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The State of New York has created a Participant Ombudsman Program called the Independent Consumer Advocacy Network (ICAN) to provide participants free, confidential assistance on any services offered by Partners Health Plan. ICAN may be reached toll-free at 1-844-614-8800 (TTY users call 711, then follow the prompts to dial 844-614-8800) or online at icannys.org.