We make it easy for care providers to submit claims electronically through one of our trusted clearinghouse partners — Change Healthcare and Office Ally. Submit, get reimbursed and get on with the important stuff — caring for your patients.

Submit a claim using Change Healthcare

Please contact your vendor to add Payor ID 33099.

Submit a claim to Office Ally

Scripps Health Plan’s Client ID number is: SHPM1. You must register to submit claims electronically through Office Ally.

To register, call 360-975-7000 and select option 3.

Complete the enrollment request form online for new users. Providers already registered with Office Ally should call 360-975-7000 option 1 for answers to questions related to claims submission.

Please remember to follow instructions below when submitting your claims to ensure acceptance.

Institutional claims direct entry

When submitting your claim, be sure you are using the correct type of bill code, such as for services with locations of inpatient, outpatient hospital, skilled nursing and home health, etc.

Special or unique billing codes

A provider whose contract has the approval to use special billing or unique billing codes, please follow these instructions:

• Special billing code(s) are to be sent at the line level (2400 loop) or the 837 claim file 
• Specify the 2400 NTE segment with qualifier of ADD (e.g.NTE*ADD*EP)
• In cases where a description needs to be sent along with the code, the caret character (^) needs to be added to separate the code from the description
• All other 5010 Requirements are to be followed

Paper claims and corrected claims submission

You may mail your claims to the following address:

Scripps Health Plan

Attention: Claims

P.O. Box 2529

La Jolla, CA 92038

Claims requiring corrections must be submitted with a Resubmission code number 7 in Field 22 on the CMS 1500 and filed 4 on the UB-04. The original claim number is required.  

Timeliness policies for commercial claims 

• Contracted providers must submit commercial claims within 90 days of the date of service. 
• Non-contracted providers must submit commercial claims within 180 days of the date of service.

Claims payment

Effective 1/1/2026 SHP will adjudicate complete claims within 30 calendar days of date of receipt 

A complete claim is defined as a claim that may be processed without obtaining additional information from the provider of service or from the patient.

SHP will pay claims at the lesser of its billed charges or at the negotiated rate and/or fee schedule whichever is less. SHP will not be responsible for paying any amount that exceeds the billed charges.

Non-contracted provider reimbursement methodology

Non-contracted reimbursement is based on a consistent, objective methodology using Medicare as the primary benchmark —not billed charges — ensuring fair, market-aligned and compliant payment determinations in alignment with DMHC regulatory requirements and NCQA standards for consistency and accuracy. For cases that are complex or when a standard methodology is not available based on category and service, a third-party vendor such as MultiPlan or Data iSight may be utilized to support pricing and reimbursement determination.

SHP uses a standardized, Medicare-referenced methodology to determine reimbursement for services provided by non-contracted providers. This approach ensures payments are:

• Consistent and equitable across all providers
• Based on nationally recognized benchmarks
• Aligned with applicable state and federal requirements, including DMHC (Knox Keene) standards for fairness and consistency and NCQA requirements for accurate, consistent claims processing

Reimbursement is calculated using:

• A Medicare-based benchmark appropriate to the service
• A standardized adjustment to reflect market-aligned value
• The lesser of billed charges or the calculated allowable amount

Billed charges are not used to determine reimbursement, as they are variable, unregulated, and do not represent market value.

All payments are determined using a uniform and consistently applied methodology, ensuring objective, repeatable, and defensible reimbursement across all non-contracted claims, consistent with DMHC expectations and NCQA standards for consistency and audit integrity.

Member Protections

In accordance with applicable laws and regulatory requirements:

• Members are responsible only for applicable cost sharing
• Members may be held harmless from additional billing in certain situations, including emergency and facility-based services
• Providers are prohibited from balance billing