Provider Information

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
 PO Box 472350
 Aurora, CO 80047

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)