MetroPlusHealth

Summary

MetroPlusHealth is a Medicaid managed care organization, part of NYC Health + Hospitals, offering dental and medical coverage operating in New York. Claims route under payer ID 13265, with 4 alternate IDs in use across clearinghouses. Provider enrollment typically takes 60-90 days, with applications through MetroPlus Provider Portal, and CAQH is used for credentialing data. Through clearinghouses it supports eligibility checks, claim status inquiries, professional claims, institutional claims, and electronic remittance (ERA); ERA enrollment is required and takes several weeks.

At a glance

Payer ID

13265Also seen as 10846, 13265MA, 2296, METPL

Also known as

MetroPlus Health Plan

Uses CAQH

YesApplication route: Payer portal application

Service area

NY (NYC)

Clearinghouse transaction setup

Which EDI transactions this payer supports, and how long clearinghouse enrollment typically takes when it is required.

Common questions

What is the payer ID for MetroPlusHealth?

The payer ID for MetroPlusHealth is 13265. Alternate IDs seen across clearinghouses include 10846, 13265MA, 2296, METPL.

How long does MetroPlusHealth provider enrollment take?

MetroPlusHealth provider enrollment typically takes 60-90 days from application to effective date. Timelines vary by state, plan, and how complete the application is.

Does MetroPlusHealth require CAQH?

Yes. MetroPlusHealth uses CAQH for credentialing data, so keep the provider's CAQH profile current and attested before applying.

Does MetroPlusHealth require ERA enrollment?

Yes. MetroPlusHealth requires a separate ERA (835) enrollment before electronic remittances flow, and setup typically takes several weeks.

What states does MetroPlusHealth cover?

MetroPlusHealth operates in NY (NYC). Coverage can differ by plan and product line, so confirm the specific plan before you file.