Coverage profile
Work MetroPlusHealth across every published route
Use the current payer record to choose the right claim-status, eligibility, portal, phone, or appeals workflow. Substrate only marks routes that are published for this payer.
Claim status
EDI 276/277The Substrate Claim Status Agent can check clearinghouse claim status for your practice with MetroPlusHealth.
Eligibility
EDI 270/271The Substrate Eligibility Agent can verify patient benefits, identify TPAs and carve-outs, and more with MetroPlusHealth.
Other aliases
Also known as
- 10846
- 13265
- 13265MA
- 2296
- METPL
- MetroPlus Health Plan
- METROPLUSHEALTHPLAN
2027 maternity billing research
When does MetroPlusHealth change OB/GYN billing?
Effective January 1, 2027, global obstetric codes are replaced by itemized visit-level codes and are no longer payable. Providers must bill the appropriate non-bundled antepartum, labor, and delivery codes. The notice says New York Medicaid adopted these coding changes effective June 1, 2026.
- Transition start
- 2026-06-01 — New York Medicaid adoption stated in the notice
- Billing start
- 2027-01-01 — global obstetric codes no longer payable
- Published
- Not stated in source
- Current As Of
- October 2026
Scope: MetroPlusHealth Medicaid, HARP, and HIV-SNP.
NYSDOH Changes to Global Obstetric Codes. Verify the payer source before claim submission.
Frequently asked questions
MetroPlusHealth payer FAQs
How do I check claim status with MetroPlusHealth?
Providers check MetroPlusHealth via EDI 276/277 when the payer ID is accepted. Substrate automates claim status across 3,500+ payers.
What is the payer ID for MetroPlusHealth?
The primary payer ID for MetroPlusHealth is 13265. The correct routing ID can differ by clearinghouse and transaction, so compare the 837P, 837I, 835, 270, and 276 entries before submitting.
What are the 837 payer IDs for MetroPlusHealth?
The 837P and 837I payer ID for MetroPlusHealth is 13265 via Stedi.
What is the 835 payer ID for MetroPlusHealth?
The 835 payer ID for MetroPlusHealth is 13265 via Stedi.
What is the 270 payer ID for MetroPlusHealth?
The 270 payer IDs for MetroPlusHealth are 13265 via Stedi and 13265 via Availity.
What is the 276 payer ID for MetroPlusHealth?
The 276 payer IDs for MetroPlusHealth are 13265 via Stedi and 13265 via Availity.
What state does MetroPlusHealth operate in?
MetroPlusHealth operates in NY.
Routing reference
MetroPlusHealth payer IDs and operating states
Use the payer ID listed for the transaction you are submitting. Verify current routing and enrollment requirements with your clearinghouse.
| Payer name | MetroPlusHealthSource: Substrate payer directory · data last changed |
|---|---|
| Operating states | NYSource: Substrate payer directory · data last changed |
| 837P professional claims payer IDStedi | 13265Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 837I institutional claims payer IDStedi | 13265Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 835 ERA payer IDStedi | 13265Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDStedi | 13265Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDAvaility | 13265Source: Availity payer catalog · catalog dated · matched by payer ID |
| 276 claim status payer IDStedi | 13265Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 276 claim status payer IDAvaility | 13265Source: Availity payer catalog · catalog dated · matched by payer ID |
Routing sources and verification
- Substrate payer directoryPayer identity, aliases, operating states, and vendor IDs. Data last changed ; checked .Open payer website ↗
- Stedi payer catalogMatched by payer ID; matched record: MetroPlusHealth. Source dated .PrimaryPayerId is used as the transaction payer ID when the corresponding Stedi support flag is true.Open current Stedi reference ↗
- Availity payer catalogMatched by payer ID; matched record: METROPLUS HEALTH PLAN. Source dated .The attached API workbook supplies 270 and 276 payer IDs only. It does not supply 837P, 837I, or 835 IDs.Open current Availity reference ↗
- United Clearinghouse payer catalogMatched by payer name; matched record: MetroPlusHealth. The source did not provide a publication date.The attachment supplies payer names and states only; it does not contain transaction-specific payer IDs.Open current United Clearinghouse reference ↗
Clearinghouse payer IDs are transaction-specific and can change. Confirm the current payer list and the member’s ID card before submission.
Payer contact directory
MetroPlusHealth phone and fax numbers
Use the number associated with your task. These contacts were stated in successful eligibility responses and may apply to specific benefits, products, or departments.
- Eligibility / benefits phone
- (855) 656-0361CVS CAREMARK
- Eligibility / benefits fax
(516) 228-9571HEALTHPLEX, INC.
| Channel and number | Payer Notes | Department | Specialties |
|---|---|---|---|
fax(516) 228-9571 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
| phone(855) 656-0361 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Pharmacy |
| phone(888) 468-2183 | Eligibility / benefitsBenefit context: Contact Following Entity for Eligibility or Benefit Information |
| Dental Care |
Phone and fax numbers sourced directly from the payer response