Provider Pulse

Your lifeline to Essence news and resources

Do you have practice changes to report to Essence? Complete the Provider Demographic form if you’re changing an address (physical location or billing) or NPI number (adding or removing providers). Visit the Provider Portal to review all the details and to access the form.

Get Ready for 2026

The Health Plan Benefit documents are now available on your Provider Portal. This includes access to EOC booklets, PAMs, and other helpful guides and resources. Additional documents will be posted closer to year-end. We encourage you to check back periodically for the latest updates.

Thank You for Joining Our First Provider Expo

Thank you to everyone who participated in our first-ever Essence Healthcare Provider Expo in St. Louis and Chicago. The events focused on strengthening partnerships, sharing key updates and fostering meaningful collaboration across our network. We appreciate your engagement in supporting local communities by assembling hand-tied fleece blankets and emergency kits for distribution. Your feedback at our events was valuable and we look forward to continuing to work together to deliver high-quality care for our members.

Important Part D Updates

We’re excited to share that more than 98 percent of drugs on our formulary will be covered at the same level or better in 2026 compared with 2025. Highlights for 2026 include expanded insulin coverage, new preferred brands for blood glucose meters and tier 6 insulin at $0 copay on all HMO plans. For more information review the Prescription Drug Coverage section of this page.

Visit the Provider Portal to access the 2026 formulary to prepare for prescription and refill requests in the new year.

Reminder to Check Member ID Cards in the New Year

Some Essence members will receive new member ID numbers in 2026 due to plan updates. Please get updated copies of the member ID cards from your Essence patients and update your records with the new numbers. Using the 2026 member ID numbers in all communications with Essence will help prevent delays and ensure accurate processing.

Health Outcomes Survey (HOS): Valuable Tool for Patient Care

Essence Healthcare is participating in the annual HOS to further our ongoing commitment to enhancing patient care and improving health plan outcomes. Use our Provider Tip Guide to stay informed about fall risk, mental health, physical activity and urinary incontinence. You’ll find a list of questions to ask your patients, educational videos and more.

Our Healthy Living Hub educates our members on these topics as well.

Managing New Part D Star Measures for Remainder of 2025

The Concurrent Use of Opioids and Benzodiazepines (COB) and Polypharmacy - Use of Anticholinergic Agents (Poly-ACH) are two new measures introduced this year that aim to reduce harm by identifying patients taking potentially dangerous combinations of medications and prompting providers to address the risks. The Essence monthly gap in care tracker helps highlight your at-risk patients for clinical review and intervention. The evaluation of all clinical alternatives is recommended before initiating new prescriptions of these high-risk medications.

Strengthening Community Connections

We’ve partnered with trusted organizations this year to support healthy aging and wellness in the Greater St. Louis area.

Aging Ahead
  • Sponsored meals and distribution for older adults to promote food security and social connection.
  • Partnered on co-branded PBS messages highlighting fall prevention and caregiver support to connect older adults to local resources.
Oasis
  • Sponsored community education through tai chi and Matter of Balance classes, providing 100 Essence bags with cooling towels for participants.
  • We also sponsored a free Falls Prevention & Technology Fair that offered resources on reducing fall risk and improving technology skills to more than 200 attendees, with 66 vaccines administered on-site.
  •  
desktop icon

Visit the Provider Portal to:

  • View member information.
  • Check claim status.
  • Manage referrals and authorizations.
  • Access the Lumeris technology suite.
  • So much more.
Provider Portal

Need help creating a Provider Portal account? See instructions.

Want to know if a corrected claim is needed?

Follow our flow chart.

Programs to Support Claims Adjudication—Effective June 1, 2025

EXL for Post-Payment Reviews
We'll use ExlService.com, LLC (EXL) for post—payment reviews of outpatient claims concerning our Medicare Advantage plans. Acting as a subcontractor under Essence Healthcare, EXL is fully compliant with HIPAA and HITECH Act requirements, ensuring the confidentiality and security of PHI shared for auditing purposes.

ED Outpatient Facility Reimbursement with Optum ED Claim Analyzer
We've made revisions to the Emergency Department (ED) outpatient facility Evaluation and Management (E/M) coding reimbursement for all plans. We will employ the Optum Emergency Department Claim (EDC) Analyzer tool, which evaluates appropriate E/M coding levels based on claim data elements such as the:

  • Patient’s presenting problem
  • Diagnostic services performed
  • Patient complicating conditions
 
Log in to your Provider Portal to access all the resources below.

Search for Referrals/Authorizations

Click on the “Referral and Authorization Inquiry” tab to use our search tool. You can search by referral or authorization number, or by member ID.

Create and Edit a Referral

For detailed instructions on how to create, edit or print an existing referral review the Referral Guide on the Referrals & Authorizations page.

Prior Authorizations

The Referrals & Authorizations page also includes helpful lists for our HMO and PPO plans to help you determine when a service requires prior authorization.

Improvements—Survey Feedback

  • Provider staff can request prior authorization directly through our Provider Portal.
  • Coming soon: Real-time authorization responses for eligible services.
  • Empowered medical office staff through technology training to improve patient care.

For questions about these improvements, please send an email to providerservices@lumeris.com.

If you disagree with the amount Essence has paid on a claim or line, a provider dispute can be submitted in writing or through the Provider Portal. We don't accept fax submissions.

Send written pay disputes to:

Essence Correspondence or Claim
P.O. Box 5907
Troy, MI 48007

To submit your pay dispute electronically, log in to the Provider Portal and navigate to the Claims tab. Scroll to the bottom and complete the Provider Pay Dispute form.

Submitting Prescription Orders or Forms

Mail-Order

To submit Part D prescription drug orders, call Express Scripts mail-order pharmacy provider services at 1-888-327-9791. Direct Essence members to log in to their Essence Member Website to access the Express Scripts member portal.

Part D Determination/Exception

Submit forms to Express Scripts.
Fax: 1-877-251-5896
Phone: 1-800-935-6103
Call Essence Customer Service at 1-866-597-9560 to request a Part D coverage determination.

Real-Time Prescription Benefit Tool

Use the Real-Time Prescription Benefit Tool to check 2025 Part D formulary coverage and any applicable formulary Utilization Management requirements. This tool displays out-of-pocket drug cost estimates in the EMR to help the physician and patient decide on the best medication based on both medical necessity and cost-effectiveness.

To check provider credentialing status, please find your area in the list below and send an email.

Arkansas: littlerockcred@essencehealthcare.com

Kentucky: loulexcred@essencehealthcare.com

Missouri/Illinois: stlouiscred@essencehealthcare.com

Chicago: chicagocred@essencehealthcare.com

Ohio: cincinnaticred@essencehealthcare.com

MEMBER RESOURCES
BENEFITS

Benefit Information and Updates

Flexible Benefits Card: Medical copay coverage, OTC and More

What’s changed?
  • OTC benefit added to Advantage Select (HMO) and Advantage Choice Plus (PPO) plans in the Chicago area.
  • Medical copay coverage no longer offered in the Mid-Missouri area.

For member-specific benefits, visit the “Eligibility” section of your Provider Portal. Members can check benefits by logging in to EverythingEssence.com.

Many Essence plans offer the ability to use the Flex Card for certain medical copays.

Accepted Medicare-covered copay categories:

  • Doctor/provider visits (including telehealth, occupational, speech and physical therapy, substance abuse, mental health sessions, podiatry)
  • Urgent care
  • Diagnostic services (such as labs, X‑rays, CT scans, MRIs and therapeutic radiology)
  • Dental, eye exam, hearing, acupuncture and chiropractic visits

Declined Charges

For Flex Card use on medical copays, the card must be eligible and used for services in an accepted copay category (shown above). If the card has this benefit and is being declined, the member’s balance could be low. Members can check their card balance on the Essence Flex Spend app or on the Member Website.

Depending on the plan, Flex Cards can be used for non-Medicare-covered dental, vision and hearing items and services, medical copays and/or OTC items. Not all categories apply to all plans.

The allowance for dental, vision, hearing and medical copays (if applicable) is loaded annually at the start of membership.

Members in plans that include the OTC benefit will receive a quarterly allowance that’s separate from the allowance for other Flex Card categories (if available in their plan), but members will use the same Flex Card for all allowed categories. The OTC allowance is valid at eligible physical retail locations or the online Essence OTC store.

The Flex Card may be used with in- or out-of-network providers. HMO plan members using the card for medical copays must stay in the Essence network.

Oura Ring

What’s changed?
  • Oura Ring benefit added to nearly all HMO plans. It is not included on the Essence Advantage (HMO) plan in the St. Louis area.
  • More finishes and colors available.
  • Members eligible to receive a new Oura Ring every two years.


Oura Ring and Data Sharing

Eligible plan members can receive a free Oura Ring as part of their plan benefits. This wearable health tracker provides real-time, reliable insights into key health metrics, like sleep quality, activity level, heart rate, average blood oxygen and more.

We’re encouraging members to share this data with their providers. Oura Ring data can help you assess wellness trends, identify health issues, develop intervention strategies and—overall—provide more personalized, proactive care for your patients.

Essence is working with Oura to automate data sharing and deliver it to you electronically. We will be communicating with you once this functionality is available.

  • The Oura Ring is the only research-validated wearable in market that directly measures from the arteries in your fingers.
  • Oura measures resting heart rate at 99.9% reliability compared to a medical-grade ECG and validated against the sleep lab golden standard—PSG.
  • Oura measures heart rate variability at 98.4% reliability compared to medical-grade ECG.
  • Oura’s temperature sensors match performance with research-grade sensors at >99 percent and are able to detect baseline deviations as small as 0.13 degrees Celsius.
  • Oura’s infrared PPG sensor matched performance with clinical-grade ECG and consistently outperformed other PPG tools relying on green light LEDs or the iPhone camera.
  • Oura’s new sleep staging algorithm was found to achieve 79 percent agreement with gold-standard PSG for 4-stage sleep classification (wake, light, deep, and rapid eye movement (REM) sleep).

For member-specific benefits, visit the “Eligibility” section of your Provider Portal. Eligible members can learn more about this benefit by visiting EverythingEssence.com/s/OuraRing.

Vision Partner: EyeMed®

We partner with EyeMed®—a leader in vision benefits, focusing on choice, convenience and savings. Members can find in-network providers by calling EyeMed at 1-833-918-0475 or visiting EyeDocLocator.EyeMedVisionCare.com/Essence/en-us.

Providers can see a list of vision providers by using our online search tool.

All plans, except Essence Advantage® Premier Plus (PPO) include routine vision benefits and an eyewear allowance. Most plans also include a preloaded Flex Card that can be used on vision services and eyewear.

For member-specific benefits, visit the “Eligibility” section of your Provider Portal. Eligible members can learn more about this benefit by logging in to EverythingEssence.com.

Prescription Drug Coverage

What’s changed:
  • $0 insulins now available on all HMO plans.
  • Deductibles: Plans with a Part D deductible will see a slight increase in 2026.
  • Diabetic testing supplies: Effective January 1, 2026, Roche and Abbott will be the preferred brands for diabetic blood glucose meters and test strips. See Diabetic Testing Supplies section below for more information.
  • Effective September 30, 2025, FreeStyle Libre® 2 sensors and FreeStyle Libre® 3 sensors will be discontinued. Members can use the FreeStyle Libre 2 Plus sensors or the FreeStyle Libre 3 Plus sensors, respectively, with their Libre 2 or Libre 3 continuous glucose monitors. Members who have a prior authorization (PA) for the FreeStyle Libre 2 or 3 sensors and get them at the pharmacy, will need to have the PA updated.

Initial coverage: Members pay $0 for preferred generics at preferred pharmacies and by mail order, and low copays for brand-name drugs.

Part D out-of-pocket max (end of initial coverage phase): $2,100

Catastrophic coverage: Members pay $0 for all covered Part D drugs

Members must meet their Part D deductible (if applicable) before standard cost-sharing applies.

For member-specific benefits, visit the “Eligibility” section of your Provider Portal. Members can learn more about this benefit by logging in to EverythingEssence.com.

Essence now partners with Express Scripts® for prescription drug benefits, including mail-order benefits.

New mail-order prescriptions should be sent to Express Scripts mail-order pharmacy. You can contact Express Scripts by phone: 1-888-327-9791.

Preferred pharmacies include CVS, Sam‘s Club, Walmart and many others.

For a complete list of preferred pharmacies, use our online search tool. Members can view their plan’s provider directory on EverythingEssence.com.

Essence members can visit the “Pharmacy” section of EverythingEssence.com for a direct link to the Express Scripts member portal (for claims information, mail-order signup, formulary and more).

Preferred-brand diabetic blood glucose meters and test strips are Abbott and Roche brand products. LifeScan is considered non-preferred.

Members can learn how to get a new preferred-brand glucose meter or test strips free of charge by visiting the “Pharmacy” section of EverythingEssence.com. Once on the pharmacy page, members will click “Diabetic Testing Supplies at Network Pharmacies.” You can access this form here.

Dental Coverage

All plans include dental coverage for no additional premium. Specific benefits are determined by the individual plan chosen.

Included benefits:

HMO Plans

HMO plan members have built‑in preventive dental coverage, which includes cleanings, exams, X‑rays and fluoride treatment within the Liberty Dental Plan network. Members using the Flex Card for additional dental services may see out‑of‑network providers.

To find an in-network dental provider, members can visit LibertyDentalPlan.com/Find‑a‑Dentist/Find-a-Dentist or contact LIBERTY Dental Plan at 1‑866‑609‑0822.


Flexible Benefits Card

All plans, except Essence Advantage Premier Plus (PPO), include a Flexible Benefits Card, which covers non‑Medicare‑covered dental items and services, such as fillings, implants, dentures, crowns and more. Members can visit EverythingEssence.com or check Chapter 4 of their Evidence of Coverage booklet for more information.

Members of all Essence plans receive Medicare-covered dental benefits, such as dental work done in an inpatient hospital setting or dental work required because of other covered medical procedures or services.

Transportation

In select markets, some Essence plans include a simple, flexible way to get to medical appointments and pharmacies—with Uber.

Plans that include this benefit: Advantage (HMO) and Advantage Plus (HMO) in the St. Louis area, and Advantage (HMO) in the Louisville and Lexington areas.

How It Works
  • 20 One‑way rides to approved medical locations within the U.S. (scheduled or on‑demand), in comfortable Uber vehicles
  • Rides must be connected to members’ medical benefits (doctor’s offices, pharmacy, rehab clinics, dental, vision and hearing appointments, and more)
  • Members can request rides by phone (1-866-974-3585), or use the convenient Uber app to request rides and track a driver in real time.
  • Door-to-door service or wheelchair accessible rides must be scheduled by phone, and at least 24 hours in advance.
  • Members can call the number above if they miss a scheduled ride; however, accessible vehicles may be more difficult to book immediately.

Flexible Benefits Card: Medical copay coverage, OTC and More

What’s changed?
  • OTC benefit added to Advantage Select (HMO) and Advantage Choice Plus (PPO) plans in the Chicago area.
  • Medical copay coverage no longer offered in the Mid-Missouri area.

For member-specific benefits, visit the “Eligibility” section of your Provider Portal. Members can check benefits by logging in to EverythingEssence.com.

Many Essence plans offer the ability to use the Flex Card for certain medical copays.

Accepted Medicare-covered copay categories:

  • Doctor/provider visits (including telehealth, occupational, speech and physical therapy, substance abuse, mental health sessions, podiatry)
  • Urgent care
  • Diagnostic services (such as labs, X‑rays, CT scans, MRIs and therapeutic radiology)
  • Dental, eye exam, hearing, acupuncture and chiropractic visits

Declined Charges

For Flex Card use on medical copays, the card must be eligible and used for services in an accepted copay category (shown above). If the card has this benefit and is being declined, the member’s balance could be low. Members can check their card balance on the Essence Flex Spend app or on the Member Website.

Depending on the plan, Flex Cards can be used for non-Medicare-covered dental, vision and hearing items and services, medical copays and/or OTC items. Not all categories apply to all plans.

The allowance for dental, vision, hearing and medical copays (if applicable) is loaded annually at the start of membership.

Members in plans that include the OTC benefit will receive a quarterly allowance that’s separate from the allowance for other Flex Card categories (if available in their plan), but members will use the same Flex Card for all allowed categories. The OTC allowance is valid at eligible physical retail locations or the online Essence OTC store.

The Flex Card may be used with in- or out-of-network providers. HMO plan members using the card for medical copays must stay in the Essence network.

Oura Ring

What’s changed?
  • Oura Ring benefit added to nearly all HMO plans. It is not included on the Essence Advantage (HMO) plan in the St. Louis area.
  • More finishes and colors available.
  • Members eligible to receive a new Oura Ring every two years.


Oura Ring and Data Sharing

Eligible plan members can receive a free Oura Ring as part of their plan benefits. This wearable health tracker provides real-time, reliable insights into key health metrics, like sleep quality, activity level, heart rate, average blood oxygen and more.

We’re encouraging members to share this data with their providers. Oura Ring data can help you assess wellness trends, identify health issues, develop intervention strategies and—overall—provide more personalized, proactive care for your patients.

Essence is working with Oura to automate data sharing and deliver it to you electronically. We will be communicating with you once this functionality is available.

  • The Oura Ring is the only research-validated wearable in market that directly measures from the arteries in your fingers.
  • Oura measures resting heart rate at 99.9% reliability compared to a medical-grade ECG and validated against the sleep lab golden standard—PSG.
  • Oura measures heart rate variability at 98.4% reliability compared to medical-grade ECG.
  • Oura’s temperature sensors match performance with research-grade sensors at >99 percent and are able to detect baseline deviations as small as 0.13 degrees Celsius.
  • Oura’s infrared PPG sensor matched performance with clinical-grade ECG and consistently outperformed other PPG tools relying on green light LEDs or the iPhone camera.
  • Oura’s new sleep staging algorithm was found to achieve 79 percent agreement with gold-standard PSG for 4-stage sleep classification (wake, light, deep, and rapid eye movement (REM) sleep).

For member-specific benefits, visit the “Eligibility” section of your Provider Portal. Eligible members can learn more about this benefit by visiting EverythingEssence.com/s/OuraRing.

Vision Partner: EyeMed®

We partner with EyeMed®—a leader in vision benefits, focusing on choice, convenience and savings. Members can find in-network providers by calling EyeMed at 1-833-918-0475 or visiting EyeDocLocator.EyeMedVisionCare.com/Essence/en-us.

Providers can see a list of vision providers by using our online search tool.

All plans, except Essence Advantage® Premier Plus (PPO) include routine vision benefits and an eyewear allowance. Most plans also include a preloaded Flex Card that can be used on vision services and eyewear.

For member-specific benefits, visit the “Eligibility” section of your Provider Portal. Eligible members can learn more about this benefit by logging in to EverythingEssence.com.

Prescription Drug Coverage

What’s changed:
  • $0 insulins now available on all HMO plans.
  • Deductibles: Plans with a Part D deductible will see a slight increase in 2026.
  • Diabetic testing supplies: Effective January 1, 2026, Roche and Abbott will be the preferred brands for diabetic blood glucose meters and test strips. See Diabetic Testing Supplies section below for more information.
  • Effective September 30, 2025, FreeStyle Libre® 2 sensors and FreeStyle Libre® 3 sensors will be discontinued. Members can use the FreeStyle Libre 2 Plus sensors or the FreeStyle Libre 3 Plus sensors, respectively, with their Libre 2 or Libre 3 continuous glucose monitors. Members who have a prior authorization (PA) for the FreeStyle Libre 2 or 3 sensors and get them at the pharmacy, will need to have the PA updated.

Initial coverage: Members pay $0 for preferred generics at preferred pharmacies and by mail order, and low copays for brand-name drugs.

Part D out-of-pocket max (end of initial coverage phase): $2,100

Catastrophic coverage: Members pay $0 for all covered Part D drugs

Members must meet their Part D deductible (if applicable) before standard cost-sharing applies.

For member-specific benefits, visit the “Eligibility” section of your Provider Portal. Members can learn more about this benefit by logging in to EverythingEssence.com.

Essence now partners with Express Scripts® for prescription drug benefits, including mail-order benefits.

New mail-order prescriptions should be sent to Express Scripts mail-order pharmacy. You can contact Express Scripts by phone: 1-888-327-9791.

Preferred pharmacies include CVS, Sam‘s Club, Walmart and many others.

For a complete list of preferred pharmacies, use our online search tool. Members can view their plan’s provider directory on EverythingEssence.com.

Essence members can visit the “Pharmacy” section of EverythingEssence.com for a direct link to the Express Scripts member portal (for claims information, mail-order signup, formulary and more).

Preferred-brand diabetic blood glucose meters and test strips are Abbott and Roche brand products. LifeScan is considered non-preferred.

Members can learn how to get a new preferred-brand glucose meter or test strips free of charge by visiting the “Pharmacy” section of EverythingEssence.com. Once on the pharmacy page, members will click “Diabetic Testing Supplies at Network Pharmacies.” You can access this form here.

Dental Coverage

All plans include dental coverage for no additional premium. Specific benefits are determined by the individual plan chosen.

Included benefits:

HMO Plans

HMO plan members have built‑in preventive dental coverage, which includes cleanings, exams, X‑rays and fluoride treatment within the Liberty Dental Plan network. Members using the Flex Card for additional dental services may see out‑of‑network providers.

To find an in-network dental provider, members can visit LibertyDentalPlan.com/Find‑a‑Dentist/Find-a-Dentist or contact LIBERTY Dental Plan at 1‑866‑609‑0822.


Flexible Benefits Card

All plans, except Essence Advantage Premier Plus (PPO), include a Flexible Benefits Card, which covers non‑Medicare‑covered dental items and services, such as fillings, implants, dentures, crowns and more. Members can visit EverythingEssence.com or check Chapter 4 of their Evidence of Coverage booklet for more information.

Members of all Essence plans receive Medicare-covered dental benefits, such as dental work done in an inpatient hospital setting or dental work required because of other covered medical procedures or services.

Transportation

In select markets, some Essence plans include a simple, flexible way to get to medical appointments and pharmacies—with Uber.

Plans that include this benefit: Advantage (HMO) and Advantage Plus (HMO) in the St. Louis area, and Advantage (HMO) in the Louisville and Lexington areas.

How It Works
  • 20 One‑way rides to approved medical locations within the U.S. (scheduled or on‑demand), in comfortable Uber vehicles
  • Rides must be connected to members’ medical benefits (doctor’s offices, pharmacy, rehab clinics, dental, vision and hearing appointments, and more)
  • Members can request rides by phone (1-866-974-3585), or use the convenient Uber app to request rides and track a driver in real time.
  • Door-to-door service or wheelchair accessible rides must be scheduled by phone, and at least 24 hours in advance.
  • Members can call the number above if they miss a scheduled ride; however, accessible vehicles may be more difficult to book immediately.
MARK YOUR CALENDAR

Coming Soon! Our Provider Services team will begin reaching out to our provider partners in January 2026 to schedule benefit overview meetings.

REGULATORY CHANGES
April 1, 2025
The Qualified Medicare Beneficiary (QMB) Program
All Medicare providers, even those that do not accept Medicaid, are prohibited under federal law from billing members in the QMB Program for their cost-share of covered Parts A and B services, including Part B-covered prescription drugs, and are prohibited from discriminating against QMBs by refusing service because of this cost-share protection. Essence encourages providers to establish processes to routinely identify the QMB status of members. Essence offers several options to help identify QMB status:
  • Contact the Plan’s customer service team
  • Review the member profile on the Provider Portal
  • Submit a 270-transaction set to inquire about Medicare eligibility. Medicare providers can seek payment for Medicare cost-sharing for QMB-eligible members from the member’s state Medicaid program. Please consult the applicable state Medicaid program for information on billing processes that apply to seeking payment from Medicaid.
 
April 30, 2025
Balance Billing
In accordance with CMS rules, as an Essence network provider, network providers are not permitted to balance bill Essence members. The term “balance billing” refers to billing a member for more than the plan-allowed cost-sharing for a covered service or billing a member for a covered service Essence denied. The Essence member is held harmless for payment beyond the Essence cost-share (copayment or coinsurance). The provider’s remit notice indicates whether an amount is owed by the member and that’s what the provider should follow when billing the member. If a member qualifies for state assistance you may see codes on your remittance notice which limit the ability to balance bill.
 
FREQUENTLY ASKED QUESTIONS

When a member disagrees with a decision made by their health plan regarding the services or benefits covered under Part C or Part D, they can appeal. The member has the right to ask for this decision to be reviewed if they think it's wrong. This can include if the health plan is taking too long to approve or arrange the care or drugs needed, or if the member thinks they should pay less for a service or drug.

Contracted providers have the right to a pay dispute rather than an appeal. If you disagree with the amount Essence has paid on a claim or line a provider dispute can be submitted in writing or through the Provider Portal. We don’t accept fax submissions.

Send written pay disputes to:
Essence Correspondence or Claim
P.O. Box 5907
Troy, MI 48007

To submit your pay dispute electronically, log in to the Provider Portal and navigate to the Claims tab. Scroll to the bottom and complete the Provider Pay Dispute form.

Many Essence plans offer the ability to use the Flex Card for certain medical copays.

Accepted Medicare-covered copay categories:

  • Doctor/provider visits (including telehealth, occupational, speech and physical therapy, substance abuse, mental health sessions, podiatry)
  • Urgent care
  • Diagnostic services (such as labs, X-rays, CT scans, MRIs and therapeutic radiology)
  • Dental, eye exam, acupuncture and chiropractic visits

Declined Charges

For Flex Card use on medical copays, the card must be eligible and used for services in an accepted copay category (see above list). If the card has this benefit and is declined, the member’s balance could be low. Members can check their card balance on the Essence Flex Spend app or on the Member Website (EverythingEssence.com).

For more information on the Flex Card, see the “Benefit Information and Updates” section on this page.

Mail-Order

Pharmacy provider services

Phone: 1-888-327-9791

Part D Determination/Exception

Submit forms to Express Scripts.

Fax: 1-877-251-5896

Phone: 1-800-935-6103

Essence members can call Express Scripts at 1-800-282-2881 (TTY: 1-800-759-1089) to get help with their prescriptions.

For general provider questions or to get more information about an event send an email to: providerservices@lumeris.com.

If you're in the Chicago area, please send an email to: chicagomarket@lumeris.com.