Professional services include those services typically billed using a Form CMS-1500 or UB-04. Notification can be submitted via Availity Essentials, or by calling the number on the members ID card. Non-participating providers can complete thePA Exemption InquiryForm. PO Box 2277 Maryland Heights, MO 63043. Q. Q. Q. The POS will accept pharmacy transactions in the National Council for If Magellan is not responsible for paying claims, you will need to contact the claims payer directly for claims information. In addition, submitting electronically reduces postage and other paper-related expenses, and supports improvement to your overall efficiency. A. While paper claims are still accepted in most regions, we recommend providers switch to electronic claims submission. If your claim does not include the correct PO Box number, your claim may be rejected. A. Important Provider Notice. Resubmitted claims should include the Date of Original Submission and Claim number if applicable. See key details from the, You are on primary menu. How do I find out what my MIS number is?A. A list of PA exempted services or codes applicable to the Outpatient Care Categories or Inpatient Treatment/Types as indicated on your notification are available on theTX HB3459 Elective Prior Authorization (PA) Exemption Clinical Guidelines. Members must renew Medical Assistance eligibility at the renewal date. MagellanProvider For Magellan Healthcare Behavioral Health providers Click here to access MagellanProvider RadMD Contact your claim forms vendor to obtain full-color versions of the UB-04. Please refer toHIPAA compliant codesfor more information. Copy of EOP from the medical/health plan vendor substantiating their denial date. All electronic claims submissions must include HIPAA-compliant billing codes to be processed. Please reviewEDI informationfor more information about our clearinghouses. Typically, a fee is attached by the clearinghouse vendor. What should I do? If the system fails to recognize you and does not return a login and password, please contact usvia secure message or call the Provider Services Line at 1-800-788-4005. Payment of benefits is subject to the members eligibility on the date service is rendered and any other contractual provisions of the plan. Enter Yale Health in the employer search field. Q. Once the Submit button is clicked, the claim submission cannot be stopped or corrected. No. Magellan Healthcare Solutions for Behavioral Health and Wellbeing, Including Employee Assistance Plans To submit claims on Magellans website: Providers can submit claims using the Claims Courier application by signing in to the. Q. I have proof that I submitted the claim within the timely filing limits. Need more assistance? Contact Us Find answers to your top questions. Please refer to Prior Authorization Exemptions on our Utilization Management page. Q. How do I submit a claim that lists more than one visit?A. Q. To comply with Illinois Senate Bill 471, providers must offer members: Alternative Means of Communication for Claims-Related Information - General, Alternative Means of Communication for Claim-Related Information -Advocate Physician Partners. Upon receipt of a claim, Magellan reviews the documentation and makes a payment determination. Providers are responsible for verifying the members eligibility for HealthChoices coverage through the PA Medical Assistance (MA) PROMISe Eligibility Verification System: For information regarding the different options for checking EVS,click here to go to the DHS website or call1-800-766-5387for interactive (real-time) eligibility verification (24/7). Alternative Means of Communication for Claims-Related Information - General(PDF), Alternative Means of Communication for Claim-Related Information -Advocate Physician Partners(PDF). What are the benefits of using the online claims submission application? Questions related to a specific claim should be directed to the toll-free number on the member's ID card or the Explanation of Benefits. A. Magellan will not charge a fee for electronic claims submitted through our Claims Courier or Direct Submit options. Q. Please note, claims must be formatted correctly before they can be entered
In addition, some sites may require you to agree to their terms of use and privacy policy. Are there service payment requests that cannot be submitted using the online claims submission application? For Emergency Situations, Always Call 911. Rights & Responsibilities Cambria County Behavioral Health/Intellectual Disabilities and Early Intervention Program Cambria County Network of Care Website Magellanassist.com/Customer If you're in need of crisis services, please call the Cambria County Crisis Reach Line at 1-877-268-9463. A. Q. You will need to complete the current page in order to use this feature since partially completed pages may not be saved. For providers that met the necessary criteria, Prior Authorization (PA) exemptions for particular service(s) were issued effective March 1, 2023. All claims for covered services provided to HealthChoices Members must be submitted to and received by Magellan as follows: Within sixty (60) days from date of service for most levels of care except as provided below; Within sixty (60) days from date of discharge for 24/hr level of care; Within sixty (60) days of the last day of the month or the discharge date, whichever is earlier when billing monthly for longer treatment episodes of care at a 24/hr level facility; Within sixty (60) days of the claim settlement for third party claims. Do notre-submit the claim as this will result in a claim denied as a duplicate, and you may be subject to unnecessary clearinghouse charges. Q. The online claim submission application requires HIPAA compliant ICD-10 codes. Magellan Medicaid Administration (MMA) . 2023 Holiday Schedule Labor Day - Monday, September 4, 2023 - State Offices, the ColoradoPAR Program, DentaQuest and Gainwell Technologies will be closed. My claims have been rejected for invalid CPT codes. What CPT codes should I use?A. Self-enroll by creating a unique user ID and password. For Prior Authorizations, please call the phone number on the back of the member ID card. Q. I have never had a claim denied for timely filing reasons before; why is it being denied now?A. This date is based on the date of the other carriers decision. Are You A Magellan Member? A. Q. Please refer to ourCode Setsfor more information. Q. Magellan continuously looks at our processes and procedures to improve service and increase efficiencies. To submit electronic claims to Magellan, your clearinghouse needs to contact one of the Magellan clearinghouses to arrange transmission of the claims. Behavioral Health Behavioral health programs and services Specializing in the most complex, costly areas of care, Magellan Healthcare partners with states to manage behavioral health programs. Claims for services provided to HealthChoices Members who have another primary insurance carrier must be submitted to the primary insurer first in order to obtain an EOB. Its similar to the CMS 1500 claim form, with additional fields to make the application HIPAA-compliant. Although it is not preferred, providers may also submit paper claims via a CMS-1500 form (Non-Facility-Based Providers) or UB-04 form (Facility-Based Providers). The Magellan clinician will give you names and contact information of providers in our network. PO Box 2157 Maryland Heights, MO 63043. Paper Claims must be submitted to the below addresses (claims are not accepted at the Care Management Center in Newtown): MBH-Bucks, PO Box 1715, Maryland Heights, MO 63043, MBH-Cambria, PO Box 2157, Maryland Heights, MO 63043, MBH-Lehigh, PO Box 2127, Maryland Heights, MO 63043, MBH-Montgomery, PO Box 2277, Maryland Heights, MO 63043, MBH-Northampton, PO Box 2065, Maryland Heights, MO 63043. Under Magellan's policies and procedures, the standardtimely filing limit is 60 days. Q. If
Often the same error is submitted repeatedly resulting in repeated rejections. Claims for services normally submitted on a CMS-1500 or UB-04may be submitted using the online claims submission application. Q. Phone Number: (877) 263-9952 Blue Shield of CA: Payer ID: BS001 Claims Address: P.O. Will the timely filing standards be applied to claims I submitted prior to being a Magellan provider?A. Yes. Where do I send the claim information?A. Members and providers can contact Magellan Healthcare at 1-800-424-1760 (toll free number), open 24/7. Q. into the adjudication system and will remain in Claims Inquiry for 18 months. Members must renew Medical Assistance eligibility at the renewal date. The online claims submission application requires HIPAA compliant CPT codes. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. 988 Suicide & Crisis Lifeline. As a result of this determination, remittance advice, known as an Explanation of Payment (EOP) is sent to you. Press 2, for counseling and behavioral healthcare. Q. To learn more information on the 988 Suicide and Crisis Lifeline, visit our resource page. Q. 2023 Magellan Health, Inc. All Rights Reserved. For exceptions to the standard timely filing requirements for specific states and/or plans/programs, refer to your contract withMagellan and/or its affiliates; see theMagellan state-, plan-and EAP-specific handbook supplements; refer to our timely filingexception grid; or consult state and federal laws. Contact us at CaliforniaProvider@MagellanHealth.com or the Provider Services Line at 1-800-788-4005. A. To submit your suggestions, pleasecontact us. General (PDF) Alternative Means of Communication for Claim-Related Information - Advocate Physician Partners (PDF) Member Access to Behavioral Health Services. You will be given the option of printing your completed claim prior to submitting it. Claims Filing Procedures Magellan is committed to reimbursing our providers promptly and accurately. If you are unable to locate your MIS number, call the Provider Services Line at 1-800-788-4005 to request it. All non-EAP claims paid by Magellan are available through Claims Inquiry. No. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. What should I do? Contact. If this is an emergency situation, do one of the following: Call 911, go directly to an emergency room, or call your doctor or therapist for help. Your MIS number may be printed on your authorization letters or on a Magellan EOP statement. If you believe your claim was denied in error, please send your request to the appeal submission address found on the Explanation of Payment (EOP). Providers will still need to check eligibility and benefits via Availity or your preferred vendor. If claims are submitted after the timely filing limit, they will be denied for payment, subject to applicable state and federal laws. Registration information is below. Check out the current issue of Provider Focus. A. What are the benefits of electronic claims filing? Contact your claim forms vendor to obtain full-color versions of the UB-04. Your MIS number allows Magellan to process your claim efficiently. Magellan encourages our providers to submit electronic claims. Clean claims are defined as claims that can be processed without obtaining any additional information from the provider or from a third party. If you not currently registered for Availity, you can do so at no charge on Availity Essentials or by contacting Availity Client Services at 1-800-282-4548 to get access. Q. A. Q. What type of claims may be submitted using the online claims submission application? Q. A. To comply with Illinois Senate Bill 471, providers must offer members: . What if I make a mistake?A. AHCCCS 801 E Jefferson St Phoenix, AZ 85034 Find Us On Google Maps. This includes services for PAs managed by BCBSTX Medical Management, Kelsey-Seybold, Carelon Medical Benefits Management, Inc. (CarelonTM) (formerly AIM Specialty Health) or Magellan for fully insured and certain Administrative Services Only (ASO) groups. A Claims Courier Demo can be accessed at: Claims Courier is a free web-based data entry application. For Magellan Rx Pharmacy specialty medication needs, please call us at 866-554-2673 Monday through Friday, 8am - 10pm Eastern. If you began entering new information on a page that is not yet saved, and decide to access information on a previous page, you will be prompted to save the current page prior to moving to another page. Click to skip to content, You are on secondary menu. If you receive a notice that Magellan accepted your claim, you can check the status of your claim through the Claims Inquiry application after securely logging on to the Magellan provider website. The EOP includes details of the payment or the denial. 2023 Magellan Health, Inc. All Rights Reserved. To get started: 1 (866) 939-6013 1 (866) 939-6013 BlueCard Eligibility: onlinehhin.hmsa.comBlue Exchange button Eligibility: call 1 (800) 676-2583 1 (800) 676-2583 Provider inquiries 948-6280 1 (800) 648-3190 Customer Relations (PPO, HMO, Medicare Advantage) Carelon Medical Benefits Management, Inc. (formerly AIM Specialty Health) is an independent company that has contracted with BCBSTX to provide utilization management services for members with coverage through BCBSTX. For information regarding the different options for checking EVS, click here to go to the DHS website or call 1-800-766-5387 for interactive (real-time) eligibility verification (24/7). This functionality is available for claims transactions with a status of Received/ Accepted. Availity provides administrative services to BCBSTX. Page 6 | Magellan Rx Management Provider Manual 1.0 Introduction Magellan Rx Management, LLC (Magellan) is the Pharmacy Benefit Manager (PBM) for the Plan. Yes, Magellan offers our providers a browser-based online claims submission application for professional services. The fees charged by these clearinghouses are in addition to fees Magellan absorbs for each EDI transaction. A follow-up appointment within 20 business days. Provider Appeals (Claim Disputes) Process; CSoC Standard Operating Procedures (SOP) . Magellan Behavioral Health of Pennsylvania (Magellan) welcomes you as a "provider" in HealthChoices and to Magellan. Click herefor best practices on submitting claims to Magellan. Blue Cross and Blue Shield of Texas contracts with Magellan Behavioral Health, Inc. (Magellan), an independent company, to administer BCBSTXs managed mental health program. There are several reasons claims may not be paid upon their first submission. Blue Shield of California; use contact information below.) It depends on the type of claim you are submitting. As the PBM, Magellan will administer the point-of-sale (POS) system to process pharmacy claim transactions. However, our contracted clearinghouses do charge fees based on your ability to submit a HIPAA-compliant (X12) transaction. A. Do I have to enter something in every field?A. Q. Magellan recommends Claims Courier for low volume claim submitters who dont want to use a clearinghouse. And best of all, filing online claims using the browser-based application is free to providers that have secure access to the Magellan provider website. Users will obtain immediate feedback regarding the results of the test to ensure compliance with HIPAA rules and codes. The site may also contain non-Medicare related information. Provider sends HIPAA transaction files directly to and receives responses from Magellan without a clearinghouse. Through this option, providers submit an 837 file to a third party middle-man who in turn submits the files to Magellan. Electronic claims filing allows for earlier detection of errors and drastically reduces the likelihood of claims being rejected or denied for payment, and often results in faster processing. The PO Box number that you would normally mail your paper claims to is required to make sure your claim is processed correctly. Box 843421 Los Angeles, CA 90084-3421 Do the timely filing limits apply to this claim?A. Why was my claim denied? See key details from the, Claims/ Check Eligibility/ View Authorizations, You are on primary menu. Will Magellan continue to accept paper claims? The easy-to-remember number provides those experiencing mental health-related distress a more accessible way to receive help. Sales & Proposals If you would like to be contacted by a Magellan sales representative, please use the form below. Yes. UB-04 For facility-based professional services. Find your provider portal As a Magellan network provider, what is my timely filing limit?A. Blue Cross and Blue Shield of Texas, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). Claims Courier is an 837P compliant application. A. For Claims Inquiry (adjustments requests; information on denial reasons), please please call the Provider Contact Center at 800-424-5891. A. After reviewing the rejection notice, the claim should be corrected and re-submitted. Does Magellan accept electronic claims submission? No, this service is offered free to Magellan providers who have secure access to the Magellan provider website. A. Reminder: Requesting Notification Acknowledgements. Member and Family advocate for Northampton County Magellan Attn: Cambria County Claims. A. The MIS number makes sure the claim is paid to the appropriate provider and at the appropriate rates. Magellan Health Services of California - Employer Services P.O.