Welcome from RiverSpring Health Plans. We have provided below some basic information and materials. Please feel free to reach out to us with any questions.
Billing, Claims and Payment Information
How to Submit a Claim
Claims can be submitted via paper or electronically, although processing and payment of electronically submitted claims will be quicker.
Paper Claims:
Providers must submit the applicable, completed and legible forms to:
ElderServe Health, Inc. d/b/a RiverSpring Health Plans
c/o Relay Health
1564 Northeast Expressway
Mail Stop HQ-2361
Atlanta, GA 30329
Electronic Claims:
RiverSpring has partnered with Change Healthcare, as our electronic claim submission gateway. Change Healthcare is a cost‐ effective, long‐term solution for managing HIPAA‐compliant 837 EDI transactions for claim submissions. RiverSpring Payer ID: 05178
To sign up with Change Healthcare Clearinghouse:
- Visit: https://www.changehealthcare.com/solutions/medical-network/claiming-remittance or,
- Call: 1‐877‐831‐4338
Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA):
RiverSpring has engaged Payspan’s claim reimbursement and remittance advice/explanation of payment (EOP) service. EFT is the direct deposit of claim reimbursements into your bank accounts. For more information or to obtain a copy of an EOP, please:
- Visit: payspanhealth.com/nps
- Call: 1-877-331-7154 for information on how to enroll in EFT/ERA.
- Log into Payspan Provider Portal at: https://www.payspanhealth.com/nps/login.aspx
For Claim Inquiries or Disputes, please contact:
- RiverSpring at Home: MLTCClaims@elderservehealth.org
- RiverSpring MAP & RiverSpring Star: Claims@riverspringhealthplans.org
Provider Participation
If you are interested in joining the RiverSpring network, please email Providerrelations@elderservehealth.org and include the following information in your request:
- Provider Name and Services
- National Provider Identifier(NPI)
- Contact Information
Provider Materials & Compliance
- False Claims Act Summary
- Fraud Waste and Abuse Training
- Provider Manual
- Model of Care Training
- Code of Conduct
- NYDOH Provider Disclosure Certificate
Important Message: Effective January 1, 2023, coverage of Adult Vaccines Recommended by the Advisory Committee on Immunization Practices Under Medicare Part D and Cost-Sharing for Covered Insulin Products Under Medicare Part D of the Inflation Reduction Act of 2022 are required.
- Important Message About What our members Pay for Vaccines – Our plan covers most Part D vaccines at no cost. Call us for more information.
- Important Message About What our Members Pay for Insulin – Members won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on, even if they haven’t paid their deductible.
- Important Message About What You Pay for certain Prescriptions – Beginning April 1, 2023 you will not pay more than the co-insurance amount for Chemotherapy administration services including chemotherapy/radiation drugs or Other drugs covered under Part B of original Medicare.
- Important Message About What You Pay for Insulin – Beginning July 1, 2023, you will not pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter the cost-sharing tier it’s on, even if you have not paid your deductible.
Please visit the CMS link for more information: https://www.cms.gov/newsroom/fact-sheets/inflation-reduction-act-lowers-health-care-costs-millions-americans