Claims

Claims Processing

Claims are processed as they are received. Claims must be submitted within 95 days from the date of service unless otherwise specified in a service agreement.

Electronic Claims: 

Payer ID: TCMAP

Clearinghouse: Trizetto

Group IDs

• MAP: 53210000
• MAP Basic: 53230000
• MAP Basic Dental Only: 53220000

Paper Claims Mailing Address:

Central Health

PO BOX 17337

Austin, TX 78760

If you are not contracted with the Travis County Healthcare District dba Central Health, please call Central Health Provider Reimbursement and Network Services at 512-640-4513 regarding claims.

Payment

For providers contracted with Central Health, use the following link to enroll with Electronic Fund Transfer (EFT): 

• EFT Form: Complete and submit to Central Health Finance at finance@gxitma.net
• Electronic Remittance Advice (ERA): Enrollment set up via the provider’s clearinghouse

Check Status of Claims

Sendero: 

• Online: Provider | Portal (eixsys.com)
• Phone: 512-978-8669 or toll free at 844-316-2004

*Providers contracted with Ascension Seton or Seton Health Plan: Go to http://www.seton.net/health-plan/providers/ for information regarding claims, payments, etc.

Providers contracted with Ascension Seton or Seton Health Plan can visit http://insurance.ascension.org/tx-charity for more information regarding authorization information.

For information regarding claims or payment, contracted providers may reach out to the Seton Health Plan directly at 855-285-6627 or emailing the provider relations team at shpproviderservices@seton.org

Refunds

If you identify MAP claims that have ben overpaid, or if a member becomes eligible for other medical coverage, the new coverage will be considered primary. In such cases, claims previously paid by Central Health should be refunded.

Please submit the following information:

• A check issued to Central Health for the amount of the overpayment
• The name and MAP ID number of the member associated with the overpayment
• The relevant dates of service
• A letter detailing the reason for the refund
• Any additional documentation that may assist in accurately processing the refund

Refunds should be mailed to:

Central Health

P.O. Box 17337

Austin, Texas 78760

Travis County Health District, doing business as Central Health, is not associated with the Central Health Medicare Plan based in California.

Providers seeking updates regarding claims should refer to the contact information provided below.

CENTRAL HEALTH MEDICARE PLAN

CALL: 1-866-314-2427

WRITE: PO BOX 14244, ORANGE, CA 92763

EMAIL: memberservices@centralhealthplan.com

Subrogation:

Subrogation is the right to recover amounts paid by a government-sponsored plan that are the obligation of other payers (such as an insurance company). If a patient is injured or becomes ill under circumstances in which a third party may legally be obligated to pay the medical, dental and/or pharmacy expenses, MAP will reimburse for covered services. Central Health and Ascension Texas (formerly known as Seton), however, have the right to be reimbursed from the settlement or judgment paid by a third party for all medical expenses incurred.  Other providers may have similar subrogation rights in any settlement or judgment made by a third party. Currently, Central Health does not assert its subrogation rights for any services.  For questions, or to submit a subrogation request, please email subrogationrequests@gxitma.net or call 512-978-8510. Ascension Texas reserves its subrogation rights with respect to services delivered at Ascension hospitals or by Ascension providers.

Anyone seeking to resolve any liens for services delivered by Ascension, related to subrogation, should contact: Edward “Brad” Gerstner (EGerstner@R1RCM.com) for acute care/facility billing and Clara Rodriguez (CLRodriguez@ascension.org) for professional billing.