INSURER FILING GUIDE
Sentara Health Plans
Use this public information to prepare your packet, then confirm the route on the insurer's own page.
AT A GLANCE
Claim facts
| Member form | MEDICAL/BEHAVIORAL Direct Member Reimbursement Form Number: SHP_MULTI_MEM_FORM_250001_0425 / Y0174_0425_SHPMR_380002_C Revision: 2025-04 (printed in month/year order) Open the insurer form |
|---|---|
| Portal upload | NO |
| Portal path | NO: the current instructions and reimbursement form publish only a nonportal submission route |
| Mail address | SENTARA HEALTH PLANS MEDICAL CLAIMS, Attention: Member Reimbursement, P.O. Box 8203, Kingston, NY 12402-8203 |
| Fax | Not published by the insurer |
| Attachments | Provider Tax ID and NPI if applicable; provider name and address; member name and health plan ID; dates of service; diagnosis and service type; diagnosis and CPT codes and description; charge for each service; dated proof of payment |
| Deadline | 365 days after the date of service |
| Outcome and status | Sentara Health Plans member portal or mobile app > claims tracker |
| Processing time | Typically 14 to 30 days; the companion instruction says normal processing time is 30 days |
| Caveats | The current reimbursement form expressly covers medical and behavioral services. Individual HMO plans do not cover ordinary out-of-network care except stated or authorized situations; employer POS or PPO terms may differ. Medicare and Medicaid are outside this read. |
STEP BY STEP
Filing steps
Read date: 10-09-2026
Research steps
- Confirm that the plan covers the out-of-network service. Current individual HMO materials limit ordinary out-of-network coverage, while employer POS or PPO terms may differ. https://www.sentara.com/en/health-plans/plans/individual/transparency-in-coverage
- Complete the MEDICAL/BEHAVIORAL Direct Member Reimbursement Form. Add an itemized bill with the published provider, member, date, diagnosis, service, code, and charge fields, plus dated proof of payment. https://shc-p-001.sitecorecontenthub.cloud/api/public/content/b88e320cfda04cd997afc48ba6f7e44b?v=e2db3de2
- Sign and date the form. Applicable reimbursement can only be made payable to the primary cardholder. https://shc-p-001.sitecorecontenthub.cloud/api/public/content/e8d5fdabcc8d41d8854eede626d55467?v=77ee4de7
- NO PORTAL UPLOAD: the current instructions and form publish only a nonportal submission route. Claims must arrive within 365 days after service. https://shc-p-001.sitecorecontenthub.cloud/api/public/content/b88e320cfda04cd997afc48ba6f7e44b?v=e2db3de2
- Track the claim in the Sentara Health Plans member portal or mobile app. The form says normal processing typically takes 14 to 30 days. https://www.sentara.com/en/health-plans/members/features/get-the-sentara-health-plans-mobile-app https://shc-p-001.sitecorecontenthub.cloud/api/public/content/e8d5fdabcc8d41d8854eede626d55467?v=77ee4de7
Filing facts
- Portal upload: NO
- Portal: Sentara Health Plans claim instructions
- Portal path: NO: the current instructions and reimbursement form publish only a nonportal submission route
- Mail address: SENTARA HEALTH PLANS MEDICAL CLAIMS, Attention: Member Reimbursement, P.O. Box 8203, Kingston, NY 12402-8203
- Fax: NOT PUBLISHED
- Attach: provider Tax ID and NPI if applicable; provider name and address; member name and health plan ID; dates of service; diagnosis and service type; diagnosis and CPT codes and description; charge for each service; dated proof of payment
- File types: NOT PUBLISHED
- File size limit: NOT PUBLISHED
- Maximum files: NOT PUBLISHED
- One file or separate files: Completed reimbursement form, itemized bill, and dated proof of payment
- Confirmation: NOT PUBLISHED
- Status check: Sentara Health Plans member portal or mobile app > claims tracker
- Processing time: Typically 14 to 30 days; the companion instruction says normal processing time is 30 days
- Member deadline: 365 days after the date of service
- Deadline basis: The current instructions and form state the same limit; employer plan document still controls coverage
- Mental health route: Sentara Health Plans Behavioral Health and Medical Claims
Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.
Read on 10-09-2026 from https://shc-p-001.sitecorecontenthub.cloud/api/public/content/e8d5fdabcc8d41d8854eede626d55467?v=77ee4de7. Confirm the address, fax number or portal path on the insurer's own claims page before you send.