Use the links below to access claims information, forms, and provider tools.
If you can’t find what you’re looking for or have any questions, please contact our Provider Relations team.
Provider Relations
Phone: 315-477-9280 | Email: providerrelations@nascentiahealth.org
Claims Processing
Paper Claims:
Nascentia Health Options
P.O. Box 22008
Tampa, FL 33622-2008
Electronic Submission:
Payor ID 31626
Electronic Funds Transfer:
Providers can enroll in Electronic Funds Transfer (EFT) through our payment partner, Echo Health. EFT enrollment allows payments to be deposited directly into your designated bank account, providing a secure and efficient payment process.
To enroll in EFT, please contact Echo Health directly. Echo Health has a dedicated customer support team available to assist with enrollment and setup at (888) 834-3511.
Claims Customer Service:
(315) 477-9509
Prior Authorizations
- Prior Authorization Requirements (pdf)
- Public Reporting of Prior Authorization Metrics – Calendar Year 2025 (pdf)
Online Forms
- Combined Credentialing Application
- Complete this form for the credentialing or recredentialing of providers offering any of the following service types:
- Certified Home Health Agency (CHHA)
- Durable Medical Equipment (DME)
- Outpatient Occupational Therapy (OT)
- Outpatient Physical Therapy (PT)
- Outpatient Speech Therapy (ST)
- Skilled Nursing Facility (SNF)
- Complete this form for the credentialing or recredentialing of providers offering any of the following service types:
- New Service Provider Application
- Complete this form for new service providers offering any of the following service types:
- Adult Day Care (ADHC, SADC)
- Audiologist/Hearing Aids
- Consumer-Directed Personal Aid (FI)
- Home and Safety Modification
- Licensed Home Care Services Agency (LHCSA)
- Meals Provider
- Complete this form for new service providers offering any of the following service types:
- Recredentialing Form
- Complete this form for new service providers offering any of the following service types:
- Adult Day Care (ADHC, SADC)
- Audiologist/Hearing Aids
- Consumer-Directed Personal Aid (FI)
- Home and Safety Modification
- Licensed Home Care Services Agency (LHCSA)
- Meals Provider
- Complete this form for new service providers offering any of the following service types:
- Contact Information Update
- General Information Update
- Health Insurance Claim (1500) (pdf)
- Physician Attestation/Mileage Reimbursement Form (pdf)
- Physician’s Order For Personal Care/Consumer Directed Personal Assistance Services (pdf)
- Provider Compliance Program Attestation
Last Updated on August 7, 2026