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:
Phone: 315-477-9280
Email: providerrelations@477home.org

Claims Processing

Claims Processing

Paper Claims:
 Nascentia Health Plus
 P.O. Box 472350
 Aurora, CO 80047

Electronic Submission:
 Payor ID 31626

Claims Customer Service:
 315-477-9509

Form – Contact Information Update Form

Form – Contact Information Update Form

Complete the Contact Information Update Form

Form – General Information Update Form

Form – General Information Update Form

Complete the General Information Update Form

Form – Health Insurance Claim (1500) Form

Form – Health Insurance Claim (1500) Form

Download the Health Insurance Claim (1500) Form (pdf)

Form – Service Provider Application

Form – Service Provider Application

Complete the Service Provider Application

Form – Recredentialing Form

Form – Recredentialing Form

Complete the Recredentialing Form

Provider Portal

Provider Portal

Visit the Nascentia Health Provider Portal

Last Updated on June 11, 2021