800-637-0171, press 3 If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. %%EOF 17806 IH 10 West, Bldg II, Suite 200 A. EAP providers can request an EAP authorization by leaving a brief voicemail message. P.O. Claims must be submitted and received by us within 24 months after the service takes place to be eligible for benefits. Magellan recommends Claims Courier for low volume claim submitters who dont want to use a clearinghouse. For a guide on how to fill out Provider ID# - Box 33b on the 1500 Claim Form, view page 56 of theNational Uniform Claim Committee (NUCC) 1500 Health Insurance Claim Form Reference Instruction Manual. Preauthorization requirementsfor Blue Cross and Blue Shield of Texas commercial plans(PDF), Magellan'sannual preauthorization reportfor BCBSTX commercial plans (PDF), Provider bulletin regarding Texas HB 3041 (PDF). 1 Magellan Behavioral Health of Pennsylvania evaluation including claims data, the Consumer Health Inventory survey, and housing and income data Availity provides administrative services to BCBSTX. Need Help? Select Blue Cross Blue Shield Global or GeoBlue if you have international coverage and need to find care outside the United States. %PDF-1.7 2615 Calder St, Suite 700 BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. UB-04 claims Blue Cross Blue Shield of Michigan P.O. 75890 or the EDI Support Mail Box:[email protected]. HealthTrio Connect : Mailing address (for paper claims): Blue Shield of California Mental Health Service Administrator (MHSA) P.O. x]rFwVa1)dJr#Qk%QKQ[93 yvk#Y _wOOOaxzXn&Wrru;8}N7o|Q2l1}e/_{12|qE2QPQ&/=d_W?F|)eAW+@y^n|"Gc9zOh The Texas Department of Insurance developed the form to be used to request prior authorization for services for commercial insured members, Medicaid, Medicaid Managed Care, the Childrens Health Insurance Program (CHIP), plans covering employees of the state of Texas, school districts, and the University of Texas and Texas A&M systems. Austin, TX 78759-7228 All Rights Reserved. 1-800-637-0171, press 3 or 1-713-663-1149 2 Magellan Pennsylvania provider data, July 2017-June 2018 Looking to contact Magellan Rx Management? The form cannot be used for any other purpose except to request prior authorization of a healthcare service. Authorization In an effort to make the authorization process easier for our EAP providers, New Directions EAP offers an authorization prompt on its telephone system (800-624-5544, prompt 3). What should I do? Within BCBSTX-branded Payer Spaces, select the Applications tab and click the BCBSTX Medicaid Provider Appeal Request Form. Providers Are you a provider looking for information on Magellan plans, joining our network, or performing secure transactions related to your practice or Magellan members? (336) 774-5400. Yes. The following items when submitted with your appeal may be considered evidence that your claim was submitted in a timely manner: Q. The Blue Cross Blue Shield Association is an . As a Behavioral Health-Managed Care Organization (BH-MCO), Magellan manages members' benefits in coordination with you - our network providers. Box 660044 Note: If you are a Blue Cross and Blue Shield of Alabama customer and need to reach us by phone, please use the telephone number(s) on the back of your ID card. This date is based on the date of the other carriers decision. Through increased access to evidence-based treatment options and effective preventive measures, we are making it easier for members to recover and stay out of hospitals. Horizon BCBSNJ: 1-800-624-1110 or 1-800-626-2212. Key Contact Information 2022 Magellan Health, Inc. All Rights Reserved. Magellan Behavior Health Services coordinates all behavioral health (mental health and chemical dependency) services for Medicaid (STAR), CHIP, and STAR Kids members. Box 9000 London, KY 40742 Phone: (866) 510-8778 Blue Shield Medicare Advantage Blue Shield Medicare Advantage Plan P.O. 1-800-749-0966 A Claims Courier Demo can be accessed at: Claims Courier is a free web-based data entry application. Note: For the requests below, utilize the indicated links: All other inquiries submit an email by selecting the office closest to your location and provide the Tax Identification Number, NPI, and if applicable, Medicare Numbers for your provider when contacting Network Management. Richardson, Texas 75082. The ERA can be automatically posted to your patient accounting system. Select the best option and fill out a form and we will reach out to you as soon as possible! Read about our progress in the 2021 GuideWell Social Impact Report. 1-915-496-6600, press 2 Box 310166 Detroit, MI 48231-0166. One option is Adobe Reader which has a built-in reader. Attn: Predetermination Dept. Blue Cross Blue Shield of Arizona 2444 W Las Palmaritas Dr. Phoenix, AZ 85021 . Care Management Contact Information . Medicaid Phone Number. PDF File is in portable document format (PDF). Medicare Plus Blue SM PPO claims Blue Cross Blue Shield of Michigan P.O. Q. I have never had a claim denied for timely filing reasons before; why is it being denied now?A. Fax: 713-663-1227 Box 272540, Chico CA 959272540 Phone Number: (800) 541-6652 Is Blue Shield MHSA the same as Magellan? Registertoday with no set-up fees, monthly fees or per-claim fees charged to providers by visiting theAvaility websiteand selecting"Register". Dental Blue Book eManual; Dental Blue News; Dental Enrollment and Credentialing; This practice is called balance billing and is not permitted. This means that, subject to applicable state or federal laws, claims must be submitted toMagellan within 60 days of the date of service or inpatientdischarge. 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). TennCare Provider Services 1-800-852-2683. Direct Submit supports HIPAA 837P and 837I claims submission files. 1001 E. Lookout Drive. *interactive voice response (IVR) system to access, you must have document control number (claim number), Blue Cross and Blue Shield of Texas Medicaid. BCBS Prefix List. ), For services managed by Magellan: BCBSTX providers who receive paper checks and Provider Claim Summaries (PCSs) via the U.S. Mail may wish to consider the electronic alternatives listed below for greater efficiency, convenience and security of information. Magellan Center for Recovery and Resiliency, Magellan Youth Leaders Inspiring Future Empowerment (MY LIFE), Digital emotional wellbeing for every day, Magellan Genetic Testing Information Request, Request More Information about Magellan Healthcares DecisionPoint, Nurse navigation and Wellness Recovery Teams focused on improved physical, and behavioral health, as well as the social determinants of health, You are on primary menu. Blue Shield Initial Appeal Resolution Office Attn: Hospital Exception and Transplant Team P.O. For urgent requests only: . Please note: as these requirements can be subject to change, thegrid may not contain a complete list of exceptions. Connect with us about any general, media or sales inquiries. You are responsible for verifying the member's coverage at the time of service. Visit our Provider Portals English View help topics or login via our member website. Email to submit provider inquiries and questions, Blue Cross and Blue Shield of Texas Braven Health: 1-888-444-0501. Claim Status; For Availity-related questions, please visit the Availity Essentials website or contact Availity Essentials Client Service at 1-800-282-4548, 8 a.m. to 8 p.m. The Magellan timely filing standards (or in accordance with your state law) will be applied to claims for services rendered after you joined the Magellan network. Please send your claims for imaging procedures to the following address: BlueAdvantage Operations 1 Cameron Hill Suite 0002 Chattanooga TN 37402-0002 Please continue to use EDI claims submission. 3 0 obj Our innovative care coordination, case and utilization management programs, and vast network of behavioral health and specialty providers facilitate improved access to cost-effective and quality care while improving quality of life for the members we serve. Behavioral Health Program Blue Cross and Blue Shield of Illinois (BCBSIL) manages behavioral health services for all commercial, non-HMO members who have behavioral health benefits through our group or retail products. Upon receipt of a claim, Magellan reviews the documentation and makes a payment determination. Box 91059 Seattle, WA 98111-9159 *Washington Regence Blue Shield P. O. Our innovative approach includes: These programs not only address the symptoms of addiction; they also address the causes. If your state has multiple brands (WA, CA, OR, NY, NJ, to name just a few) then you'll want to ask for the exact address to file to. Clean claims are defined as claims that can be processed without obtaining any additional information from the provider or from a third party. Sign up to receive information and updates from Magellan Healthcare on behavioral health webinars and education! Many times, primary care physicians are the first place a member goes when they have a problem. From February 15 to September 30, on weekends and holidays, you may be required to leave a message. Dallas, TX 75266-0241 We provide free eligibility and benefits verification as part of our billing . 052 1366489049; 052; 1366489049 Franciscan PHO Northern IN Hammond; Claims Inquiry Patty Arredondo; Julie Lambertino; 7905 S Calumet Ave Munster; IN 46321 (219) 836-5800 66347 (219) 836-8025 [email protected]; . You are leaving this website/app (site). Blue Shield of California welcomes you. 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. 2. The new Texas Clinicians Postpartum Depression Toolkit is intended to be a resource for Texas clinicians on screening, diagnosis and treatment of postpartum depression. Fax: 361-852-0624 Instructions for submitting requests for predetermination <> Upon receipt of the completed form(s), Magellan will begin the prior authorization process. Click the link below to find the provider portal for your needs. In addition, some sites may require you to agree to their terms of use and privacy policy. Magellan was the first MBHO to have a program included in this publication. General Member Service Correspondence. 1001 E Lookout Drive Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. Become an Anthem provider and join the nation's second- largest health plan-owned behavioral health company, serving more than 13 . ~_IV21b~Lj Will the timely filing standards be applied to claims I submitted prior to being a Magellan provider?A. Place of Service 23. Box 21974 Eagan, MN 55121 1-800-778-2119 Verify eligibility and benefits at 1-888-356-7899 www.pearprovider.com Independence Blue Cross Federal Employee Program (FEP) PPO "R" followed by 8 numeric characters 54704 837I - 12X26 Facility Providers Claims 1Only Claims Receipt Center We're here to help answer your questions. Box 7026 Wheeling, WV 26003 Wisconsin Anthem Blue Cross Blue Shield BlueCross BlueShield of Tennessee payer ID number: 00390. When submitting claims electronically, the Magellan submitter ID is 01260. Magellan continuously looks at our processes and procedures to improve service and increase efficiencies. Magellans Primary Care Physician (PCP) Toolkit. Dallas, TX 75266-0027, Prior authorization of Medical Services for the Health Insurance Marketplace for Blue Advantage HMO Members, Eligibility and benefits contact Availity or other electronic connectivity vendor or call 1-800-451-0287*, Behavioral health services mental health and chemical dependency, For prior authorization and referrals managed by BCBSTX: (includes inpatient, residential treatment center (RTC) programs, partial hospitalization and outpatient behavioral health services). Copy of EOP from the medical/health plan vendor substantiating their denial date. Magellans PCP toolkit represents Magellans commitment to promote integration of medical and behavioral health services toward the goal of better overall outcomes for patients. Magellan is committed to the fight against the opioid epidemic and other substance use disorders (SUDs) affecting far too many of our family members and friends. If you are enrolled in a Lowe's medical plan with BCBS AL, you will contact Magellan Health for services (1-877-543-3875, press 2, then press 1). Magellan Healthcare Solutions for Complex Care Needs: Behavioral Health, Specialty Imaging, Automated Prior Authorization, Employee Assistance. For the latest information on flexibilities and extensions due to COVID-19, refer to theTexas Medicaid & Healthcare PartnershipandTexas Health and Human Services Commissionwebsites. Claims submission address: Blue Cross and Blue Shield of Texas P O Box 660044 Dallas, TX 75266-0044. This new site may be offered by a vendor or an independent third party. endobj endobj Contact Magellan Health Services or call 1-800-788-4005 For prior authorization, benefits, eligibility, or claims status or questions contact Magellan at 1-800-327-7390 Effective 6/27/2022, a Behavioral Health Service Coordination can help members manage complex conditions related to mental health and substance use. However, if a provider wishes to request a prior authorization by mail or fax using a form, it must be this form as prescribed by the Texas Department of Insurance. General Information: 1-972-766-6900. Behavioral Health Services are provided byMagellan Health Services. What is the appeals process? Claims Submission. Electronic claims filing system, Benefit disclosure information (form available online), Online: Use Availity Attachments application, Mail form to: 168 0 obj <>/Filter/FlateDecode/ID[<50CE1069D31C234C87CF13730B148C38><945CA0064BA9D246BD7A3657988FAEE3>]/Index[136 60]/Info 135 0 R/Length 140/Prev 151563/Root 137 0 R/Size 196/Type/XRef/W[1 3 1]>>stream To verify eligibility or obtain authorization, you may contact Magellan at 1-800-424-4399. . Its similar to the CMS 1500 claim form, with additional fields to make the application HIPAA-compliant. Magellan's Caroline Carney, MD, MSc, FAPM, CPHQ, recently co-chaired the National Quality Forum Committee with funding from the Centers for Medicare & Medicaid Services (CMS) to develop guidance for healthcare stakeholders to successfully implement the Opioids and Behavioral Health Measurement Framework and ultimately help combat the opioid crisis. The Subscriber Claim Summary includes the name of the health care provider who sent us the claim, the date of service, the type of service (lab, surgery, medical care, etc.) Behavioral health benefits are integrated into Anthem medical plans for a full spectrum of coordinated care for our members. BlueCross BlueShield of Tennessee is a Qualified Health Plan . Copyright 2022Health Care Service Corporation. <> Contact Magellan Healthcare. Please select the appropriate version of the form below based on the members you serve. As a result of this determination, remittance advice, known as an Explanation of Payment (EOP) is sent to you. Claim forms must be submitted to: Blue Cross and Blue Shield of Alabama. San Antonio, TX 78257-8222 <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 24 0 R 25 0 R 26 0 R 27 0 R 30 0 R] /MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 195 0 obj <>stream Why was my claim denied? You should also check with your billing service, clearinghouse or software vendor to confirm ERA-compatibility and availability of auto-posting software. Postpartum depression is a common, potentially serious and sometimes life-threatening condition. (out-of-state subscribers) Most people don't view their physical and mental health as separate, and neither do we. Secure Provider Web Portal (Electronic Verification System - EVS) Online Provider Enrollment (OPE) Online Prior Authorization (PA) system Online Claims Submission Online Provider Claim Appeals Audio Response System (ARS) (800-942-6511) Real time CAQH/CORE EDI eligibility and claim verification Provider PASRR Nevada Medicaid COVID-19 Mailing address (for paper claims): Magellan Health Services . Fax to: 1-888-579-7935 Find your provider portal Blue Cross and Blue Shield of Texas - Claims PO Box 660044 Dallas, TX 75266-0044 How to submit an international claim You can submit your completed international claim form and documentation using one of the following methods: By mail: Service Center P.O. Please [email protected] any questions. Customer Service. Blue Cross and Blue Shield of Illinois 300 East Randolph Street Chicago, Illinois 60601-5099. This new site may be offered by a vendor or an independent third party. Box 30271 Salt Lake City, UT 84130-0271 *Washington Regence Group Administrators Attn: Claims P. O. P.O. Place of Service 22. There are several reasons claims may not be paid upon their first submission. There is a simple testing process to determine if Direct Submit is right for you. Contact Availity or other electronic connectivity vendor or call 1-800-451-0287*, *interactive voice response (IVR) system to access, you must have full member's information (for example, member's ID, patients date of birth, etc. For service questions, such as benefits, claims, bill pay or other issues: Call: 1-800-495-2583, 8 a.m.-8 p.m . 1001 E. Lookout Drive Attention: Claim Department . D2Ed0L^lA$0D`X|6MlK(4S$3Al"@?MV3H{r qJAGg` ET, Monday through Friday. Claims Courier is an 837P compliant application. Medical Care Management <> Appeals Provider Manual June 2021 15.5 15 Requesting an appeal For all Part C and Part D standard appeals, the Member or his or her authorized representative should mail the written appeal to: Keystone 65 HMO/Personal Choice 65 PPO Member Appeals Department Pharmacy claim submission and Pro- DUR questions ; 24 hours / 7 days a week; Magellan Rx Management Pharmacy Call Center: 1-800-424-5725. Federal Employee Program claims Blue Cross Blue Shield of Michigan P.O. x}[s6{&.JIOwZd o/v//lwzv}|y_&TBn}?l.}oQdMy{~HbSMP7 s~o[}tUG0/Nyo{,J:T$aI|H@O_jVLyjV@>G77 Aug@GQO_>d+l6T5>A.1z{;|})eE&)35~5om[|{w-re^P=Jw"4Y]GW>+>4 *lBC3zcmW~\U0e.t^j2PtTU/%xz.w`]7OBu'!EW>K(>QEJ@&lh5. 9442 Capital of Texas Hwy N, Suite 500 The ERA or ANSI 835 transaction is a HIPAA-compliant method of receiving claim payment and remittance details. Email: [email protected]. The easiest way to determine your current rates is to review the current rate sheet for your Magellan or affiliate company agreement. It is important that you review all EOPs promptly. EFT is a direct deposit claim payment from BCBSTX to your designated bank account. Mail Claims or Claims Correspondence to: Blue Cross Blue Shield of Arizona P.O. Mail your payment to the address on your premium invoice or learn about other convenient ways to pay your bill. Email Us. Contact us By mail. In addition, some sites may require you to agree to their terms of use and privacy policy. . Does this timely filing limit apply to all claims for all members (e.g., COB, Medicare, etc.)?A. Fax 877-361-7646, Claims submission address: Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. Magellan Behavioral Health Providers! 1-972-766-8900 If you have a question about . By enforcing the timely filing requirement in the provider contract, we are able to focus our resources on what our providers have asked us to do - promptly pay claims. Blue Cross and Blue Shield of Illinois P.O. Apply for individual or family medical, dental, and life insurance plans. Phone: 1-713-354-7033 Explore more about our programs and services addressing behavioral health, including substance use disorder treatment, and integration with physical health. TennCare is happy to provide you an email response to your inquiry. You are leaving this website/app (site). Contact Information. stream [Maryland and WDC] Offers healthcare insurance to residents of Maryland and Washington, DC. To submit claims on Magellans website: Providers can submit claims using the Claims Courier application by signing in to the. Q. Click to skip to content. Claims Submitting Claims Claims will continue to go directly to BlueCross. Utilization Management/Medical Management/Case Management. Provider Services 1-800-521-6007 Representatives are available 24 hours a day, 7 days a week.. By email. As a Magellan network provider, what is my timely filing limit?A. Upon receipt of your message, New Directions will fax or mail you the . endstream endobj startxref 3 Magellan of Virginia NCQA Quality Improvement Activity Form, 2018. Q. 2 0 obj 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. TO AVOID DELAY, DO NOT SUBMIT FORM TO MULTIPLE AREAS/OFFICES. Blue Medicare HMO Blue Medicare PPO Contact: 1-888-296-9790 or. View the 2021 GuideWell Social Impact Report. Box 805107, Chicago, IL 60680-4112. Enforcing this clause also brings us in line with industry practices. Check member eligibility, submit and check claims and find important information and more on our provider portal. A. Main telephone number 1-215-937-8000. Member Services 1-800-521-6860 TTY: 1-800-684-5505 Representatives are available 24 hours a day, 7 days a week.. This new site may be offered by a vendor or an independent third party. Box 272640 Chico, CA 95927-2640 Double-Check Details Check your new card to ensure details like the spelling of your name and the type of plan you selected are correct. Fax: 1-713-663-1227 Behavioral Health Services: 1-800-266-6167. Box 211184 Eagan, MN 55121 The 60-day inpatient readmission rate in Pennsylvania was nearly cut in half, from 21% to 11%, for members utilizing MAT at discharge versus those who were not.2. 2022 Magellan Health, Inc. All Rights Reserved. Box 805107 Chicago, IL 60680-4112. External link You are leaving this website/app (site). 1-361-878-1623 Provider sends HIPAA transaction files directly to and receives responses from Magellan without a clearinghouse. Box 710400, San Diego CA 921710400 Phone Number: (877) 263-9952 Blue Shield of CA: Payer ID: BS001 Claims Address: P.O. Keystone First 200 Stevens Drive Philadelphia, PA 19113. Resubmissions on Claims Courier (MBH Website): changes/ corrections are allowed to Place of Service, Billed Amount, or Number of Units Only (all other corrections must be submitted via paper claim). Our approach addresses the most costly areas and most unique needs of health plans, fueling discovery of unmet clinical needs and driving innovation to improve health and financial outcomes. endobj Click the link below to find the provider portal for your needs. AIM Specialty Health (AIM) is an operating subsidiary of Anthem and an independent third party vendor that is solely responsible for its products and services. San Diego, CA 92171 . Fax: 1-713-663-1227 0 If you need to mail claims: Horizon BCBSNJ. It is important to note that depression can occur during pregnancy as well as after the baby is born. Magellan has separate post office boxes for the accounts for which we provide claims payment services. 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). Box 2064 . Services billed beyond 95 days from the date of service are not eligible for reimbursement. Most PDF readers are a free download. Together, we're committed to making a meaningful difference in the health of all Floridians. Fax: 512-349-4853 If after reviewing your rates you still believe there is an error, please contact the toll-free number on the member's ID card or the Members Explanation of Benefits, or call your Magellan network representative. In Pennsylvania, Magellan works with county partners in Bucks, Cambria, Lehigh, Montgomery and Northampton counties. Richmond, VA 23242 The site may also contain non-Medicare related information. The EOP includes details of the payment or the denial. . 1-713-663-1149 Magellan steps in for our members to help prevent and address the risks of one affecting the other. Resubmission of Claims: Claims that must be revised and resubmitted after adjudication must be stamped resubmission or otherwise noted on box 22 of the CMS-1500 form. The following address should be used for claims related to outer counties: Outer County Claims - Lehigh, Lancaster, Northampton, and Berks County Claims Receipt Center P.O. Dental Expense Claim. Again, this can be a huge time-suck, calling and being transferred over and over. Box 312599 Detroit, MI 48231-2599. To view this file, you may need to install a PDF reader program. 1-361-878-1623 Note: Predetermination requests for members with Blue Cross and Blue Shield benefits in another state should be sent to the Plan indicated on the members ID card. Participating physicians, professional providers, ancillary and facility providers may not seek payment from the member for claims submitted after the 95-day filing deadline. Magellan did not receive your resubmitted claim within our timely filing limits (or within the timely filing limits of your state) after the initial date of denial. Therefore it does not support revenue codes (codes submitted on 837I files or a UB-04). endstream endobj 137 0 obj <. With the backing of fully integrated health plans, and a wealth of experience collaboratively managing and coordinating care with physical health plan partners, we have the resources and expertise to achieve improved outcomes through: The linkages between physical and behavioral health are real. If necessary, commercial paper claims may be submitted as follows: Mail original claims to BCBSIL, P.O. Claims Address: P.O. This is the customer service number for questions about your health insurance coverage, benefits or treatment. Box 2048 Southeastern, PA 19399 Online: at www.bcbsglobalcore.com brownsville pd blogspot,