At CenterLight Healthcare, we are committed to delivering high quality health and health-related services to our members in the diverse communities we serve. This commitment is only possible through our relationship with you -- our network of caring and compassionate Providers dedicated to enhancing our participants' quality of life.
This section of our website affords our participating Providers access to a variety of useful tools and documents. Use the quick links below to obtain directories, forms and more.Provider Resources
How to Submit a Claim
If you need assistance or have any questions, please call our Provider Relations department at 1-800-761-5602.
Please click on the links below to access Provider information in pdf format.Prior Authorization Criteria (PDF, 359KB) (Last Updated April 2017)
Prior Authorization Request Form (Coming Soon)CenterLight Healthcare Quick Reference Guide (PDF. 39KB)
Provider Manual (PDF) (Coming Soon)Participant Bill of Rights (PDF, 371.2KB)
Fraud, Waste and Abuse Policy (PDF, 304KB)
Please click on the links below to access Provider Directories in pdf format.
Dental Provider Directory (PDF) (Coming Soon)Back to top of page
How to Submit a Claim
We understand that getting paid quickly and accurately is important to you and encourage our participating providers to file claims online. Online claims processing saves time and paper.
Electronic Claims Submission
Electronic claim submission provides an easier and faster way to submit claims. For all electronic claims, please register with any clearinghouse. All claims should be submitted through the Electronic Data Interchange (EDI) utilizing Payer ID: 13360.
Paper Claims Submission
If you submit paper claims, please be sure to submit claims on a CMS 1500 or a UB 04 form and always include:
- The service facility location information.
- The pay to group or individual name.
- The National Provider Identifier (NPI).
- The name of the rendering provider and rendering provider NPI
Always include the NPI and Tax Identification Number (TIN) on claims. Please refer to these sample forms (PDF, 569.9KB) which indicate the fields required to properly process a claim
Submit paper claims to:CenterLight Healthcare
PO Box 5845
Hauppauge, NY 11788
Providers should submit all claims within ninety (90) days of the date of service for prompt adjudication and payment.
For any questions regarding claims status, please call Provider Services at 1-800-761-5602, Monday through Friday, from 9 AM to 5 PM.Back to top of page