Sentara Health Plans
Part of Sentara Healthcare
Summary
Sentara Health Plans is a regional health plan, part of Sentara Healthcare, offering dental and medical coverage operating in Virginia and North Carolina. Claims route under payer ID 54154, with 10 alternate IDs in use across clearinghouses. Provider enrollment typically takes 60-90 days, with applications through Sentara 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 activates within hours.
At a glance
- Payer ID
54154Also seen as 00453, 10477, 1285, 54154MA, 5415M, 7499 and 4 more- Also known as
- Optima Health Behavioral Health, Optima Health Community Care, Sentara Behavioral Health Services, Sentara Health Administration, Sentara Health Insurance Company
- Uses CAQH
- YesApplication route: CAQH application only
- Service area
- VA, NC
Clearinghouse transaction setup
Which EDI transactions this payer supports, and how long clearinghouse enrollment typically takes when it is required.
| Transaction | Enrollment | Typical setup |
|---|---|---|
| Eligibility checks (270/271) | Not required | Immediate |
| Claim status (276/277) | Not required | Immediate |
| Professional claims (837P) | Not required | Immediate |
| Institutional claims (837I) | Not required | Immediate |
| ERA / remittance (835) | Required | Same day |
Common questions
- What is the payer ID for Sentara Health Plans?
- The payer ID for Sentara Health Plans is 54154. Alternate IDs seen across clearinghouses include 00453, 10477, 1285, 54154MA.
- How long does Sentara Health Plans provider enrollment take?
- Sentara Health Plans provider enrollment typically takes 60-90 days from application to effective date. Timelines vary by state, plan, and how complete the application is.
- Does Sentara Health Plans require CAQH?
- Yes. Sentara Health Plans uses CAQH for credentialing data, so keep the provider's CAQH profile current and attested before applying.
- Does Sentara Health Plans require ERA enrollment?
- Yes. Sentara Health Plans requires a separate ERA (835) enrollment before electronic remittances flow, and setup typically takes a few hours.
- What states does Sentara Health Plans cover?
- Sentara Health Plans operates in VA, NC. Coverage can differ by plan and product line, so confirm the specific plan before you file.
Related payers
Compiled from public payer resources and clearinghouse catalogs. Details change often, so confirm with the payer before relying on them. Spot something out of date? Tell us and we will fix it.