Coverage profile
Work Sentara Health Plans 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 Sentara Health Plans.
Eligibility
EDI 270/271The Substrate Eligibility Agent can verify patient benefits, identify TPAs and carve-outs, and more with Sentara Health Plans.
Enhanced claim status
Availity ECSPortal claim status
Browser automationThe Substrate Claim Status Agent can check claim status via the payer portal for Sentara Health Plans.
Other aliases
Also known as
- 00453
- 10477
- 1285
- 54154
- 54154A
- 54154MA
- 5415M
- 7499
- OPTSNT
- ULACG
- VACMS
- YEXEB
- Optima Health Behavioral Health
- Optima Health Community Care
- Sentara Behavioral Health Services
- Sentara Health Administration
- Sentara Health Insurance Company
- Sentara Health Management
- SENTARA
- OPTIMA SENTARA
- OPTIMA/SENTARA
Payer intelligence
Observed adjudication timing
How long completed claims in Substrate’s aggregate network took from payer receipt to the 835 payment date.
Median time to payment
8 days- 10% of adjudications by
- 5 days
- 90% of adjudications by
- 9 days
- Applicable state coverage
- VA
- Current As Of
- July 2026
Five-month median trend
Days to 835 paymentView chart data as a table
| Service month | Median | 10% of adjudications by | 90% of adjudications by | Completed claims | Coverage |
|---|---|---|---|---|---|
| Apr | 7.9 days | 5 days | 9 days | 744 | VA |
| May | 8 days | 6 days | 9 days | 1,649 | VA |
| Jun | 8 days | 5 days | 9 days | 1,562 | VA |
| Jul | 8 days | 5 days | 9 days | 1,368 | VA |
| Aug | No qualified data | ||||
2027 maternity billing research
When does Sentara Health Plans change OB/GYN billing?
Sentara’s Sept. 3 update identifies global maternity billing changes effective 2027-01-01 and says that, effective immediately, providers should bill 59425 and 59426 for pregnant Sentara members delivering after that date.
- Transition start
- Effective immediately (notice dated 2026-09-03)
- Billing start
- 2027-01-01
- Published
- 2026-09-03
- Current As Of
- September 2026
Scope: Sentara Health Plans provider update. The notice does not state which product lines or selection threshold applies to 59425 versus 59426.
Provider Updates: Noncitizen Adults on Medicaid, Behavioral Health Contracting, and More. Verify the payer source before claim submission.
Frequently asked questions
Sentara Health Plans payer FAQs
How do I check claim status with Sentara Health Plans?
Providers check Sentara Health Plans via EDI 276/277 when the payer ID is accepted. Substrate automates claim status across 3,500+ payers.
Can I automate Sentara Health Plans portal follow-up?
Yes — portal retrieval is required when 276/277 is missing or stale. See payer portal automation and learn why 276/277 is not enough.
What is the payer ID for Sentara Health Plans?
The primary payer ID for Sentara Health Plans is 54154. The correct routing ID can differ by clearinghouse and transaction, so compare the 837P, 837I, 835, 270, and 276 entries before submitting.
What is the provider portal for Sentara Health Plans?
The provider portal for Sentara Health Plans is https://apps.availity.com/. Available features depend on the payer and your account.
What are the 837 payer IDs for Sentara Health Plans?
The 837P and 837I payer ID for Sentara Health Plans is 54154 via Stedi.
What is the 835 payer ID for Sentara Health Plans?
The 835 payer ID for Sentara Health Plans is 54154 via Stedi.
What is the 270 payer ID for Sentara Health Plans?
The 270 payer IDs for Sentara Health Plans are 54154 via Stedi and 54154 via Availity.
What is the 276 payer ID for Sentara Health Plans?
The 276 payer IDs for Sentara Health Plans are 54154 via Stedi and 54154 via Availity.
What state does Sentara Health Plans operate in?
Sentara Health Plans operates in VA.
Routing reference
Sentara Health Plans 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 | Sentara Health PlansSource: Substrate payer directory · data last changed |
|---|---|
| Operating states | VASource: Substrate payer directory · data last changed |
| 837P professional claims payer IDStedi | 54154Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 837I institutional claims payer IDStedi | 54154Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 835 ERA payer IDStedi | 54154Enrollment requiredSource: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDStedi | 54154Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 270 eligibility payer IDAvaility | 54154Source: Availity payer catalog · catalog dated · matched by payer ID |
| 276 claim status payer IDStedi | 54154Source: Stedi payer catalog · catalog dated · matched by payer ID |
| 276 claim status payer IDAvaility | 54154Source: 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: Sentara Health Plans. 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: SENTARA HEALTH PLANS. 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: Sentara Health Plans. 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
Sentara Health Plans 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.
- Payer phone
- (757) 552-7410Sentara Health Plan
| Channel and number | Payer Notes | Department | Specialties |
|---|---|---|---|
| phone(757) 552-7410 |
| ||
| phone(800) 394-2237 |
| ||
| phone(800) 543-3359 |
|
Phone and fax numbers sourced directly from the payer response