Claims

How to file a claim for professional services
Are you an Ascension network provider? 
Ascension network (Tier 1) providers should submit claims to Automated Benefit Services (ABS) - SmartHealth's claim processor. 
Please follow the instructions below to ensure claims are processed in a timely manner. Claims must be received with 12 months from the date of service.**
To submit a paper claim mail to:
ABS for SmartHealth
PO Box 37705
Oak Park, MI 48237-7705

To submit an electronic claim:

Submit under Payer ID 38259 using one of the following vendors:

  • CAREVU
  • AllScripts
  • Web MD/Envoy
  • THIN
  • MCSI
  • ENS
  • ProxyMEd
  • Claimsnet.com
  • McKesson
  • NDC

Medicare supplemental claims

Please submit paper claims to the address below and type claims on HCFA 1500 claim forms. Claims for secondary payment must be received within six months from the date the primary payer processed the claim.

Submit Medicare supplemental paper claims to:

ABS for SmartHealth

PO Box 37705

Oak Park, MI 48237-7705

To avoid rejected claims, please include the following:

  • Member ID Number
  • Patient's Name
  • Patient's Birth Date and Sex
  • Insured's Group Number
  • Indication of Auto - Employment - Emergency related condition (when applicable)
  • Pre-Certification Number - include referral or Pre-Certification when applicable
  • Name of Referring Physician. If the patient self-referred, type "self"
  • Diagnosis Code (ICD-10)

 

  • Date of Service
  • Procedure Code (CPT or HCPCS when applicable, with appropriate modifiers)
  • Billed Charges
  • Number of Units
  • Total Charges
  • Provider Tax ID Number
  • Provider NPI Number
  • Provider's Billing Address and Phone Number

ABS will return claims missing any of the above information to the provider for completion.

Are you a National network or out-of-network provider?

Bill the local Blue Cross Blue Shield using the alpha prefix found on the Member's ID card.

 

ABS provider portal

Please visit the ABS provider portal to verify eligibility, view claims history and payment status.

New to the ABS provider portal? In order to gain access to this secure website, please complete and return the form, ABS provider web portal access application, via email to abssupport@abs-tpa.com.

Claim cost management

The Ascension SmartHealth program utilizes a variety of vendors and tools to ensure that claims submitted for reimbursement are bill appropriately and eligible for payment under the plan. Tools and services utilized under the program may include, but are not limited to:

  • Claim editing for bundling and unbundling
  • Up coding
  • Duplicate claim submission
  • Separate billing of services included in global care
  • Incorrect or inappropriate billing for services rendered

All coding edits are based on CPT, MPA and industry standard (NCCI) policy and guidelines.