Claims and Provider Reimbursements

The forms and information available here will help you file claims to the appropriate addresses and facilitate your reimbursements. If you need further information, please visit the Contact Us page for assistance.

Claims

Network providers may submit claims to:

PHP
PO Box 853936
Richardson, TX 75085-3936
Phone: 517.364.8432 or 877.275.0076

Or file electronically:
Payor ID: 37330
Payor Name: PHP

Non-network providers may submit claims to:

Zelis Healthcare
PO Box 247
Alpharetta, GA 30009
Phone: 800.860.1111

Or file electronically:
Payor ID: 07689
Payor Name: PHP

Non-Network Provider Reimbursements

Non-network providers are reimbursed in accordance with the Zelis Network leased pricing, as applicable, or per PHP's Non-Network standard reimbursement schedules.  In keeping with the Centers for Medicare and Medicaid (CMS) reimbursement methodologies for the mid-Michigan region, PHP's Non-Network standard reimbursement schedules are a reasonable and customary charges standard.  PHP may review and adjust these reimbursement schedules on a yearly or as market determines basis.  

Provider Appeals

PHP and Sparrow PHP have processes for documenting and responding to administrative complaints, including claim payment decisions. Claim payment disputes may be submitted in writing by mail or fax:

PHP
Attn: Provider Appeals
PO Box 30377
Lansing, MI 48909-7877

Fax: 517.364.8411
Attn: Provider Appeals

Appeals must be received within 90 days from the date of adverse determination and/or date the claim was processed.  PHP will research all claim payment disputes and provide a response within 30 days of receipt.  

Provider Check Schedule

PHP processes provider checks for all products every Monday and Thursday, as well as on the last business day of the month. If you have any questions regarding the check-writing schedule, please contact your Provider Relations Team.

Out-of-network providers may submit claims to:


Zelis
PO Box 247 
Alpharetta, GA 30009 
Phone: 800.860.1111 

Or file electronically:
Payor ID: 07689
Payor Name: PHP

Out-of-network providers may submit claims to:


Zelis
PO Box 247 
Alpharetta, GA 30009 
Phone: 800.860.1111 

Or file electronically:
Payor ID: 07689
Payor Name: PHP