Providence Health Plan

Source: https://www.providencehealthplan.com/-/media/providence/website/pdfs/members/forms/medical-claim-form.pdf

Read date: 10-09-2026

Research steps

1. Confirm that the plan has ordinary out-of-network benefits. Providence says Personal Option and cited Oregon and Washington individual plans do not have out-of-network benefits except for listed situations. https://www.providencehealthplan.com/members/how-to-use-your-benefits
2. Download Member Reimbursement Form for Medical Claims 00469, updated 2/2026. Complete the applicable member, alternate payee, service, provider, other coverage, and accident fields. https://www.providencehealthplan.com/-/media/providence/website/pdfs/members/forms/medical-claim-form.pdf
3. Attach an itemized statement or complete the form's service and provider fields. Attach proof of payment and sign the attestation. A superbill alone is not sufficient because the form and proof of payment remain required. https://www.providencehealthplan.com/-/media/providence/website/pdfs/members/forms/medical-claim-form.pdf
4. NOT PUBLISHED: a generic Providence member portal or app upload path. The current form and member page publish an offline route only, so portal_upload is NO. Do not use an offline destination from this map. https://www.providencehealthplan.com/members/how-to-use-your-benefits
5. Submit within 60 days when reasonably possible and no later than 365 days after the expense. Payment goes to the subscriber or policyholder unless the alternate payee section is completed. https://www.providencehealthplan.com/-/media/providence/website/pdfs/members/forms/medical-claim-form.pdf
6. PEBB exception: for services on or after January 1, 2026, use My Collective > Activity > Submit a claim. This exception does not establish the generic Providence route. https://www.providencehealthplan.com/public-employees-benefit-board-pebb/forms-and-benefit-information

Filing facts

• Portal upload: NO
• Portal: myProvidence status view; My Collective for PEBB only
• Portal path: No generic upload path: current form and member page publish an offline route. PEBB services on or after January 1, 2026 use My Collective > Activity > Submit a claim
• Mail address: Providence Health Plans, Attn: Claims Processing, P.O. Box 4327, Portland, OR 97208-4327
• Fax: 503-574-5940
• Attach: Dates and place of service; diagnosis codes; procedure codes; charge and amount paid; provider name, tax ID, and billing address; proof of payment; other coverage; employment or accident facts when applicable
• File types: NOT APPLICABLE
• File size limit: NOT APPLICABLE
• Maximum files: NOT APPLICABLE
• One file or separate files: NOT APPLICABLE
• Confirmation: EOB; myProvidence claim information where available
• Status check: EOB and myProvidence claim information
• Processing time: Clean claims within 30 days; delay notice within 30 days; after requested information is received, processing within 30 days
• Member deadline: Within 60 days when reasonably possible and no later than 365 days after the expense
• Deadline basis: YES: PEBB and plan documents can change the route or deadline
• Mental health route: Common medical form for most commercial mental-health claims; Southern California caregivers and PEBB have plan-specific routes

Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.