Use the links below to find helpful documents, forms and other resources. If you can’t find what you’re looking for, or have any questions or concerns, please contact our Provider Relations Team.
Provider Relations:
P: 315.477.9280
E: providerrelations@477home.org
Claims Customer Service/Portal Access:
P: 315.477.9509
Claims Processing (MLTC CLAIMS):
Paper Claims:
Nascentia Health Options
P.O. Box 981814
El Paso, TX 79998-1814
Electronic Submission:
Payor ID 31626
Forms:
Service Provider Application
Recredentialing Form
General Information Update Form
Contact Information Update Form
Health Insurance Claim (1500) Form (PDF)