MetroPlusHealth
MetroPlusHealth is a payer organization operating in New York. For an ASC, what matters isn't the logo. It's how MetroPlusHealth pays: where it runs rich, where it runs thin, and how its reimbursement compares with peer plans for the same procedures.
Pilot Analysis
Get the complete MetroPlusHealth analysis
Tell us where to send it. Our team will prepare an analysis of MetroPlusHealth covering rates by code, market position, and underpaid areas, and email it to you within 5-10 business days. Need it faster? Book a demo.
What Insights reveals
How MetroPlusHealth pays
See how MetroPlusHealth reimburses across procedures and markets, benchmarked against the peer plans competing for the same cases. Not a raw rate sheet, a read on where it sits.
Geographic footprint
MetroPlusHealth's presence spans New York. See where it concentrates and how that shapes the markets you compete in.
Peer position
Put your own position next to the benchmark for MetroPlusHealth and bring the gap to your next contract conversation.
Specialty mix
Understand which procedures and specialties drive MetroPlusHealth's volume, so you know where a rate change moves the needle.
Whether you're an ASC benchmarking a contract or a provider team looking MetroPlusHealth up, DataLily AI maps how it reimburses across procedures and markets, and where your own rates sit against the peer benchmark.
Reference
Working with MetroPlusHealth
- Payer ID
- 13265 is the EDI identifier used to route electronic eligibility checks (270/271), claim-status inquiries (276/277), and claims to MetroPlusHealth through a clearinghouse.
- Eligibility verification
- Coverage and benefits for MetroPlusHealth members are verified before the date of service, through a clearinghouse using payer ID 13265or through the payer's provider portal.
- Prior authorization
- Requirements are set per plan and per procedure. Confirm whether an authorization is required with MetroPlusHealth directly before the date of service.
Book a demo: pick a time
A 15-minute walkthrough of MetroPlusHealth the way it pays.
- What is MetroPlusHealth's payer ID?
- MetroPlusHealth's electronic payer ID is 13265. ASC billing teams use it to route eligibility checks (270/271), claim-status inquiries (276/277), and electronic claims to MetroPlusHealth through a clearinghouse.
- How do ASCs verify eligibility for MetroPlusHealth members?
- Eligibility and benefits for MetroPlusHealth members are verified before the date of service, either electronically through a clearinghouse (a 270/271 transaction using payer ID 13265) or through the payer's provider portal.
- Does MetroPlusHealth require prior authorization for ASC procedures?
- Prior-authorization requirements for MetroPlusHealth are set per plan and per procedure. Confirm whether an authorization is required with MetroPlusHealth directly before the date of service.
- What type of payer is MetroPlusHealth?
- MetroPlusHealth is a payer organization operating in New York.
- How does MetroPlusHealth compare with other payers for ASC procedures?
- Ask Rose and you get a plain-language read on where MetroPlusHealth pays above or below peer plans for your top procedures, charted, and ending in a recommendation you can take into a contract conversation.
- Is MetroPlusHealth paying my ASC below market?
- Put your own MetroPlusHealth contract next to the peer benchmark in DataLily AI and you'll see the gap by procedure and market, the fastest way to know whether you're leaving money on the table.