Extended MLTC Provider Quick Reference Guide

Provider Services

If you have any questions regarding claims status, payment or submission please dial 855-299-6492, and follow the prompts for “Providers”, then the prompt for “Provider Claim Inquiries”, email us at providers.ny@extendedmltc.net

Extended MLTC also has an Online Provider Portal available. Please go to www.extendedmltc.org and click on the Provider menu and select Provider Portal to request portal access.

Claims Submission:

- Please Note All Initial Claims are to be Submitted within 90 Days of the Date of Service -

All paper claim submissions are to be mailed to the following P.O. Box:

Extended MLTC Provider Claims
P.O. Box 21446
Eagan, MN 55121

- Please Note All Corrected Claims are to be submitted within 60 Days of the Original EOB Date -


All Claims that are being Resubmitted (Corrected Claim) or for an Appeal on a Claim

Please label the envelope and Claims form appropriately and mail to the following P.O. Box:

Extended MLTC Provider Correspondences
“Corrected Claim” or “Claims Appeal”
P.O. Box 21446
Eagan, MN 55121

Electronic Claims Submission:

The Extended MLTC Emdeon payer ID # is 46166.

Emdeon supports both professional and institutional claims.

(1) CMS-1500 (formerly HCFA 1500) This billing form is used for professional services. For instructions on completion of the CMS-1500 please refer to the “HCFA/CMS 1500 Tutorial” or the ILS Provider Manual.

(2) UB-04 This billing form is used when billing for home health care, skilled nursing, and nursing home room and board. For instructions on completion of the UB-04 please refer to the Centers for Medicare and Medicaid Services website at http://www.cms.gov or the ILS Provider Manual.

Care Management & Prior Authorization:

To obtain a prior authorization, request a referral for additional services or if you require assistance please contact Extended MLTC Member Services 855-299-6492 and press “0” to reach a Member Services department representative. Our normal business hours are Monday through Friday 8:30 AM through 8:00 PM and Saturday 10:00 AM through 6:00 PM with 24 hour on-call assistance available for emergencies.


Extended MLTC can be contacted as follows for all referrals and other general inquires (Translation Available): 1-855-299-6492
TTY/TDD Dial 711

Additional Resources

Important Announcement:

As per the National Uniform Billing Committee (NUBC), the use of Type of Bill (TOB) 33X for Home Health Services was discontinued for dates on or after October 1, 2013.
As of October 1, 2013 home health services should be billing with Type of Bill 32X. The 32X type of bill has been modified to mean “Home Health Services under a Plan of Treatment”.

Please note that Home Health claims received with Type of Bill 33X will be denied for invalid type of bill.

Additonal information is available at the following link:

Should you have any questions regarding this notification, you may contact your ILS Provider Relations Representative, at 1-888-262-1292 extension 4216 or via the Provider Services Line at 1-855-299-6492, Option 3.