Did you know? You can check claims status on our Provider Portals:

• Availity
  
  • Don't have an Availity account? You can register here for free.
    
    • If you need help using the portal: Watch a demo by selecting "Learn More" or "Watch Demo" in the upper-right corner of the tool you're using, or contact Availity at 1-800-282-4548 for assistance.
• Mirra Provider Portal

Additional Resources:

• 2026 Provider Handbook
• Quick Reference Guide
• How to Enroll in EFT Payments

Frequently Asked Questions

How do I submit a claim?
Solis accepts claims electronically and by paper. Electronic submission is preferred for faster processing.

• Electronic: Submit through Availity or your clearinghouse using Payor ID SOLIS. Submit through Availity or your clearinghouse using Payor ID: SOLIS.
  
  • Availity
    
    • Solis Payor ID: SOLIS
  • Smart Data Solution (SDS)
    
    • Solis Payor ID: 73581
• Paper: Use CMS 1500 (Version 02/12) or UB-04 forms and ensure all fields are complete. Use  forms and ensure all fields are complete.CMS 1500 (Version 02/12)UB-04 forms and ensure all fields are complete.

Paper claims can be sent to:
Solis Health Plans
Attn: Claims
P.O. Box 211486
Eagan, MN 55121

What is required for a clean claim?
A clean claim is one that can be processed without additional information or delay. To avoid denials, ensure:

• All required fields are completed
• CPT/HCPCS and diagnosis codes are valid and up to date
• The member is eligible on the date of service
• Required prior authorizations are obtained
• Coordination of Benefits, if applicable, is included

What is the timely filing requirement?
Claims must be submitted within the required timeframe:

• Contracted providers: Per your provider agreement, or within 180 days if not specified.
• Non-contracted providers: Within 12 months from the date of service.

Claims submitted after these timeframes may be denied.

Can I submit a corrected or voided claim?
Yes. Corrected, replacement, or voided claims must include the appropriate claims frequency code:

• 5: Late charges
• 7: Replacement of prior claim
• 8: Void/cancel of prior claim

For paper claims, include the original claim reference number and resubmit within 60 days of the EOP or denial.

Can I bill the member?
Providers may only bill members for:

• Copayments
• Coinsurance
• Deductibles
• Non-covered services, only if the member is notified in advance and agrees in writing.

Members may not be billed for denied services unless proper notice was given prior to the service.

How do I enroll in EFT or access EOPs?
Solis partners with Zelis for electronic payments and EOP access. You can find enrollment instructions here.

• Enroll in EFT to receive payments faster
• Access EOPs and payment details online

What should I do if my claim is denied or needs review?
If you believe a claim was processed incorrectly, you may submit a dispute or reconsideration.

• Must be submitted within 60 days of the EOP or denial.
• Include supporting documentation.

What should I do if I have an overpayment?
If you receive an overpayment notice, you are required to return the identified amount within 45 days.

Send refunds or correspondence to:‍

Solis Health Plans, Inc.
Attn: Audit and Recovery
9250 NW 36th ST, Ste. 400
Miami, FL 33178

Submitting a dispute for an overpayment:
If you believe the overpayment is incorrect, you may submit a dispute via:

• Fax: 833-615-9263
• Mail: Same address as above.

Be sure to include all supporting documentation to avoid processing delays.

What if I’m having issues submitting a claim?
If your claim submission fails or you do not receive confirmation:

• Check with your clearinghouse, such as Availity, for submission status.
• Confirm you received an acknowledgement.
• Contact your clearinghouse representative for technical issues.

Who do I contact for claim-related questions?
If you are unable to resolve your issue using the portal or FAQs, contact Provider Services for assistance at 833-615-9259.

Still have questions regarding claims?

• Send us a message and a representative will get in touch with you soon; send us a message here.
• Call Provider Services at 833-615-9259; we are open Monday - Friday, from 8 AM - 5 PM.

Did you know? You can check authorization status on our Provider Portals:

• Mirra Provider Portal
• Calypso Light

Additional Resources:

• 2026 Provider Handbook
• Quick Reference Guide
• Authorization Free Service Guide
• Request for Service Authorization Form

Frequently Asked Questions

How do I request an authorization for a member?
To request an authorization:

• First, review our Authorization Free Service Guide to confirm whether authorization is required for the requested service.
• Complete the Service Authorization Request Form and fax it to 833-210-8141.
• Authorization requests may also be submitted electronically through Calypso Light.

How long do authorization requests take to process?

Part C Authorization Requests

• Standard Requests: A determination is made within 7 calendar days of the request date when all required information is received. If additional information is needed, the timeframe may be extended by up to 14 calendar days.
• Expedited Requests: A determination is made within 72 hours. If additional information is needed, the timeframe may be extended by up to 14 calendar days.

Part B Injectable Requests

• Standard Requests: A determination is made within 72 hours of the request date when all required information is received. If additional information is needed, the timeframe may be extended by up to 14 calendar days.
• Expedited Requests: A determination is made within 24 hours when all required information is received. If additional information is needed, the timeframe may be extended by up to 14 calendar days.

How do I know if a service requires prior authorization?
Please review our Authorization Free Service Guide, which outlines services that require authorization.

What happens if prior authorization is not obtained?
For participating providers, authorization requirements may vary based on the service being rendered. If prior authorization is required and not obtained, services may be delayed, denied, or not eligible for payment. We recommend confirming authorization requirements before services are provided.

Who do I contact with authorization questions?
For questions related to authorization requests, please contact Authorization Intake at 833-615-9260.

Have additional questions regarding authorizations?

• For an authorization request, please contact Authorization Intake at 833-615-9260.
• For an authorization inquiry, please contact Provider Services at 833-615-9259 or submit a request here.

Did you know? Member eligibility can be verified through our Provider Portals:

• Mirra Provider Portal
• Availity

Additional Resources:

• 2026 Provider Handbook
• Quick Reference Guide

What does eligibility verification confirm?
Eligibility verification may confirm the following member information:

• Membership status, active or inactive.
• Plan name & type
• Coverage effective dates, when applicable.

What if a member is not showing on the portal but should be on my roster?
For participating PCPs: Monthly rosters are typically updated within 7 to 8 business days following the first of the month. If the member is still not reflected after that timeframe, please contact Provider Services for assistance.

Have additional questions regarding eligibility?

• Send us a message and a representative will get in touch with you soon; send us a message here.
• Call Provider Services at 833-615-9259; we are open Monday - Friday, from 8 AM - 5 PM.

Have interest in joining Solis Health Plans network?
Complete a Letter of Intent and we will get back to you with a status update. The completed Letter of Intent can be sent to providerrelations@solishealthplans.com.

Provider Resources:

• Quick Reference Guide

Have additional contracting questions?

• Call Provider Services at 833-615-9259; we are open Monday - Friday, from 8 AM - 5 PM.
• Send us a message and a representative will get in touch with you soon; send us a message here.