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
 P.O. Box 981814
 El Paso, TX 79998-1814

Electronic Submission:
 Payor ID 31626

Provider Portal

Forms:
Service Provider Application
Recredentialing Form
General Information Update Form
Contact Information Update Form
Health Insurance Claim (1500) Form (pdf)
Electronic Remittance Advice (835) and EFT Authorization Agreement (pdf)

Provider Updates

Suspension of Select Pre-authorization Requirements

Beginning on January 6, 2022 and for 30 days thereafter, Nascentia Health Options is suspending prior authorization requirements for:

  • Insured Transfers Between In-Network Hospitals
  • In-Network Inpatient Rehabilitation Services Following an Inpatient Hospital Stay

Please refer to the DFS letter for additional information.