Sutter Health Plan

Sutter Health Plan (formerly Sutter Health Plus) commercial HMO customer service. Providers call to confirm claim receipt, find a member's participating provider group (PPG) and its claims address, check dispute status, and — for non-participating providers — authorize post-stabilization care after emergency/urgent services. The site lists two different TTY numbers, so none is stored.

For clarification on claims pricing for providers participating through Anthem Prudent Buyer PPO, HealthSmart or other network arrangements.

Out-of-area emergency and urgent care claims for Sutter Health Plan HMO members (address is also on the back of the ID card). All other claims go to the member's participating provider group (PPG) shown on the ID card. Timely filing: 180 calendar days from date of service.

Mail the Provider Dispute Resolution Request form for claims Sutter Health Plan processed; dispute status questions go to Customer Service.

Outpatient prescription drug PA and step-therapy exception requests (California standard form) go to CVS Caremark, Sutter Health Plan's pharmacy benefit manager.

Email the Provider EDI Request form to become an Edifecs trading partner; also for EDI submission or connection problems.

Behavioral health benefits for Sutter Health Plan members are administered by Carelon Behavioral Health of California.