Provider Enrollment and Claims Submission Requirements
- Enrollment: To receive payment for services provided to an Umpqua Health member, the provider or facility must be enrolled with the State of Oregon and have an active DMAP number on the date(s) of service.
- Claims Submission: UHA accepts paper and electronic claims in HIPAA 837P, 837I, CMS-1500, or UB-04 formats. Claims are typically processed within 60 days of receipt of a clean claim. Non-clean claims typically result in a longer adjudication timeline.
- Denials: If you received a claim rejection letter from Ayin Health Solutions, please contact them directly at (503) 584-2169, option #5. Umpqua Health does not have access to those claims and Ayin Health Solutions will advise on possible solutions.
Out-of-Area Providers
If you are an out-of-area provider seeking enrollment with DMAP, please visit the Oregon Medicaid Provider Enrollment Portal. Ensure you meet all enrollment requirements as outlined in Oregon Administrative Rules OAR 410-120-1260 and OAR 407-120-0320.
Electronic Claim Submission (EDI)
- UHA accepts HIPAA-compliant 837P and 837I electronic claims.
- Electronic Data Interchange (EDI) offers a faster and more cost-efficient alternative to paper claim submissions.
- The online submission system performs a preliminary review of each claim to identify and flag common billing errors prior to acceptance.
- Please note that most requirements for paper claims also apply to EDI submissions.
For comprehensive guidelines on 837P and 837I transactions, please refer to the CMS website.
Payor IDs
Select the correct payor ID numbers based on your organization’s clearinghouse.
| Clearinghouse | PAYOR ID |
| Allscripts/PayerPath (via forwarding) | 77502 |
| Availity | 77503 |
| Cortex EDI | CIM11 |
| ClaimMD | 77501 |
| GE Healthcare/Athena | 77500 |
| Gateway/Trizetto | 77504 |
| Office Ally | 77501 |
| Relay Health PCS (Professional) | 77505-CPID 1291 |
| Relay Health PCS (Institutional) | 77505-CPID 6551 |
Paper Claim Submission
- OHA adheres to Medicare and OHA guidelines for processing of paper claims.
- Submit claims on the current CMS-1500 or UB-04 forms.
- Please see the UHA Provider Handbook for additional information.
Paper Claims Submission Address:
Ayin Health Solutions
Attn: UHA Claims
PO Box 5308
Salem, OR 97304
Claim Appeals Address:
Ayin Health Solutions
Attn: UHA Appeals
PO Box 5308
Salem, OR 97304
Timely Filing Guidelines
- Original Claims: Must be submitted within 120 days from the date of service (or discharge date for inpatient stays).
- Corrections, Appeals, and Secondary/Tertiary Billing: Must be submitted within 365 days from the date of service and must include the primary EOB/documentation.
- Providers are encouraged to submit within 30 days of the date of service to facilitate the collection of encounter data and provide effective utilization management.
If you encounter system issues or other delays affecting timely billing, UHA must be notified immediately using the Contact Us information below.
Timely Filing Appeals
Appeals must be attached to the claim. Acceptable proof of timely filing includes:
- RA/EOB, or
- A screenshot or system-generated transaction history showing the claim submission date (within timely limits), along with at least three of the following:
- Member ID
- Member name
- Procedure code
- Billed charges
- Date of service
Note: Delays due to DMAP enrollment are not considered valid reasons for untimely claim submission. Once enrollment is complete, claims are automatically reprocessed; however, the original submission must fall within the timely filing guidelines.
Please see the Umpqua Provider Handbook, Section 6: Filing Claims for more detailed information.
Contact Us
UHA Claim Support Team (available Mon-Fri, 8am –5pm PST)
