Provider FAQ

Who is Evolutions Healthcare Systems (EHS)?

EHS is one of the largest independently owned nationwide Preferred Provider Organizations PPO). We contract with Hospitals, Physicians, and Ancillary providers to create a superior network of healthcare professionals that strive to deliver exceptional service at extremely competitive rates. Our state of the art claims management software, TRX-Transaction Re-pricing & eXchange architecture, has been designed to ensure timely and accurate claims processing.

Where do I send claims?

Please refer to the back of the patient's ID card for claims routing instructions. The appropriate Payor ID# for that group will be listed for electronic submission.  Paper claims should be sent to Evolutions Healthcare Systems, unless otherwise directed. 

Who pays claims and when will I receive payment?

EHS represents over 250 payors nationwide. Claims are re-priced according to the contracted reimbursement rate within 24-48 hours and then forwarded to the Payor for adjudication and payment. EHS requires its Payors to reimburse in-network providers within thirty (30) days of receipt of a 'clean claim'. 

Do I need to use referrals?

We are an open access network and do not utilize gatekeepers. However, some of our plans may use a referral system for specific services. Please contact the Payor by calling the benefits and eligibility number on the patient's ID card for specific requirements, however whenever possible you should refer patients to an Evolutions Healthcare Systems participating provider. The network participation status of colleagues or potential referrals may be found using our Provider Search specific for that group or by contacting Provider Services

How often is the directory updated?

The EHS PPO Online Directory is connected to our “live” provider data repository. Changes to provider records are made available immediately following any update. You may search our online directory at Provider Search or contact Provider Services

How do I notify EHS of an address change or tax identification number change?

To ensure a timely and smooth transitions of information, EHS requests notification at least 60 days before an office relocation or a change in tax identification number and at least 90 days before closing your practice. Simply complete the required information on our Provider Update form. If you have further questions please contact Provider Services

How do I add a new practitioner to my participation provider agreement with EHS?

Updates may be made using our Provider Update form. If you have further questions please contact Provider Services

How can I get more information about Evolutions Healthcare Systems?

If you would like to receive additional information please contact our Provider Services Department.

NPI: National Provider Identification Number Information

Contractually, all EHS participating Providers are required to maintain their demographic information (including, but not limited to their NPI) for the purposes of providing our members with current, accurate data as well as information necessary to manage our network and assist Payers to efficiently adjudicate our Providers’ claims.  EHS is prepared to capture and record you NPI to assist Payers with the HIPAA mandate.  Providers must continue to include their Tax ID Number on all claims for tax (1099) purposes.

  • EHS will maintain NPIs (along with any other identifying information) in the strictest confidence and will only be shared as it pertains to claims adjudication.