Piedmont Community Health Plan
Piedmont Community Health Plan is a regional health plan operating in Virginia. For an ASC, what matters isn't the logo. It's how Piedmont Community Health Plan 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 Piedmont Community Health Plan analysis
Tell us where to send it. Our team will prepare an analysis of Piedmont Community Health Plan 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 Piedmont Community Health Plan pays
See how Piedmont Community Health Plan 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
Piedmont Community Health Plan's presence spans Virginia. See where it concentrates and how that shapes the markets you compete in.
Peer position
Put your own position next to the benchmark for Piedmont Community Health Plan and bring the gap to your next contract conversation.
Specialty mix
Understand which procedures and specialties drive Piedmont Community Health Plan'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 Piedmont Community Health Plan up, DataLily AI maps how it reimburses across procedures and markets, and where your own rates sit against the peer benchmark.
Reference
Working with Piedmont Community Health Plan
- Payer ID
- 55768 is the EDI identifier used to route electronic eligibility checks (270/271), claim-status inquiries (276/277), and claims to Piedmont Community Health Plan through a clearinghouse.
- Eligibility verification
- Coverage and benefits for Piedmont Community Health Plan members are verified before the date of service, through a clearinghouse using payer ID 55768or through the payer's provider portal.
- Prior authorization
- Requirements are set per plan and per procedure. Confirm whether an authorization is required with Piedmont Community Health Plan directly before the date of service.
Book a demo: pick a time
A 15-minute walkthrough of Piedmont Community Health Plan the way it pays.
- What is Piedmont Community Health Plan's payer ID?
- Piedmont Community Health Plan's electronic payer ID is 55768. ASC billing teams use it to route eligibility checks (270/271), claim-status inquiries (276/277), and electronic claims to Piedmont Community Health Plan through a clearinghouse.
- How do ASCs verify eligibility for Piedmont Community Health Plan members?
- Eligibility and benefits for Piedmont Community Health Plan members are verified before the date of service, either electronically through a clearinghouse (a 270/271 transaction using payer ID 55768) or through the payer's provider portal.
- Does Piedmont Community Health Plan require prior authorization for ASC procedures?
- Prior-authorization requirements for Piedmont Community Health Plan are set per plan and per procedure. Confirm whether an authorization is required with Piedmont Community Health Plan directly before the date of service.
- What type of payer is Piedmont Community Health Plan?
- Piedmont Community Health Plan is a regional health plan operating in Virginia.
- How does Piedmont Community Health Plan compare with other payers for ASC procedures?
- Ask Rose and you get a plain-language read on where Piedmont Community Health Plan pays above or below peer plans for your top procedures, charted, and ending in a recommendation you can take into a contract conversation.
- Is Piedmont Community Health Plan paying my ASC below market?
- Put your own Piedmont Community Health Plan 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.