Learn how to enroll online for EFT and ERA transactions by referring to theAvaility EFT & ERA Enrollment User Guide. To obtain an aggregate number of grievances, appeals, and exceptions filed with BlueRx (PDP) contact Member Services at 1-800-327-3998 (BlueRx AL) or 1-888-311-7508 (BlueRx TN), 8 a.m. to 8 p.m., seven (7) days a week. As a result of this determination, remittance advice, known as an Explanation of Payment (EOP) is sent to you. 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 Or call your doctor or therapist for help. Phone: 1-972-766-7100 1-361-878-1623 DO NOT COMPLETE THIS FORM IF YOU ARE A MAGELLAN COMPLETE CARE MEMBER OR PROVIDER. Magellan's quality improvement program to reduce inpatient mental health readmissions was selected by NCQA for inclusion in its benchmarking publication, Quality Profiles. Arboretum Plaza II 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. A. Availity provides administrative services to BCBSTX. Claims Submitting Claims Claims will continue to go directly to BlueCross. Dental Expense Claim. Will the timely filing standards be applied to claims I submitted prior to being a Magellan provider?A. Email to submit provider inquiries and questions, Blue Cross and Blue Shield of Texas 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. 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. Where do I send the claim information?A. Email to submit provider inquiries, 1001 E. Lookout Drive 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 Medicare Plus Blue SM PPO claims Blue Cross Blue Shield of Michigan P.O. For eligibility, prior authorization or claims inquiries, call 877-299-1008. Upon receipt of the completed form(s), Magellan will begin the prior authorization process. Resubmissions must be submitted within 60 days from the date of denial. 3 Magellan of Virginia NCQA Quality Improvement Activity Form, 2018. Effective 6/27/2022, a Behavioral Health Service Coordination can help members manage complex conditions related to mental health and substance use. 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 Box 2291 Durham, NC 27702-2291 . For urgent requests only: Does this timely filing limit apply to all claims for all members (e.g., COB, Medicare, etc.)?A. 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 1-800-749-0966 The easiest way to determine your current rates is to review the current rate sheet for your Magellan or affiliate company agreement. Need Help? Contact Availity or other electronic connectivity vendor or call Magellan Behavioral Health 1-800-729-2422, Claim filing address for Commercial products, Availity Essentials Box 2048 Southeastern, PA 19399 Online: at www.bcbsglobalcore.com Find My BCBS Company When the confirmation message displays, select, To enroll online for EFT, you must be a registered Availity, Texas Medicaid claims are normally finalized weekly on Mondays. A. 2 0 obj To view this file, you may need to install a PDF reader program. What is the appeals process? 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. 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. Use the link below to find your local BCBS company's website. Visit our job search tool to find and apply to a position. Copy of EOP from the medical/health plan vendor substantiating their denial date. 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. Fax: 361-852-0624 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 Blue Cross Blue Shield Association is an . Mail your payment to the address on your premium invoice or learn about other convenient ways to pay your bill. BCBS Provider Phone Number. Call 1-800-528-7264 or the phone number listed on the back of the member's/subscriber's ID card. 2022 Magellan Health, Inc. All Rights Reserved. Box 629011 El Dorado Hills, CA 95762-9011. Fax 877-361-7646, Claims submission address: Go directly to an emergency room. Magellan recommends Claims Courier for low volume claim submitters who dont want to use a clearinghouse. [Maryland and WDC] Offers healthcare insurance to residents of Maryland and Washington, DC. 1-800-336-5696 If necessary, government programs paper claims may be submitted. PDF File is in portable document format (PDF). MagellansMedical Providers Behavioral Health Toolkitgives medical practitioners the information and screening tools needed to assist in making behavioral health referrals. Do the timely filing limits apply to this claim?A. One option is Adobe Reader which has a built-in reader. Claim status inquiries (out-of-state subscribers) contact Availity or other electronic connectivity vendor. Fax: 713-663-1227 Claim forms must be submitted to: Blue Cross and Blue Shield of Alabama. Clean claims are defined as claims that can be processed without obtaining any additional information from the provider or from a third party. When you enroll for the ERA, you are automatically enrolled for the EPS, which is an electronic version of the paper PCS. Therefore it does not support revenue codes (codes submitted on 837I files or a UB-04). Florida Blue is a part of the GuideWell family of companies. 800-676-BLUE (2583). Apply for individual or family medical, dental, and life insurance plans. Copy of an EOP with a date within the timely filing period, Certified or overnight mail receipts dated within the timely filing period, Copy of the claim with Magellan's date stamp within the timely filing period, Copy of 2nd level EDI 277 acceptance reports. Once you get to your company's site, click on "Find Care" in the top menu to get to the provider search function. Select the best option and fill out a form and we will reach out to you as soon as possible! BlueCross BlueShield of Tennessee payer ID number: 00390. Richardson, TX 75082-4144 Magellan employs many methods to identify members with complex needs to match them with the appropriate level of specialized case management services, including: Our team provides the compassionate extra support individuals need to overcome significant behavioral health and life challenges. As a first step, always review the Explanation of Payment (EOP) or Explanation of Benefits (EOB) and determine the reason why the claim was denied before resubmitting a new claim. Information for Brokers, employers, and providers, as well as links to consumer health and wellness sites. 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.) *interactive voice response (IVR) system to access, you must have document control number (claim number), Eligibility and benefits contact your electronic connectivity vendor, Availity or other electronic connectivity vendor or call 1-800-451-0287*. Main telephone number 1-215-937-8000. BCBS Prefix List - Alpha. Self-enroll by creating a unique user ID and password. Fax: 361-852-0624 Customer Service: If you have questions or need additional support, BCBSTX Personal Health Assistants are available to help. Call 911. hb```@(]K@1% V!iD3 7+S#UBCm0#LiF j9vvfL4 q* Copyright 2022Health Care Service Corporation. To obtain information pertaining to your network status, contact our National Provider Line at (800) 397-1630 from 8 a.m.-8 . 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. 17806 IH 10 West, Bldg II, Suite 200 1001 E. Lookout Drive The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. 10 things to check each time you submit a claim: Q. I believe I am being paid the incorrect rate. Keystone First 200 Stevens Drive Philadelphia, PA 19113. Claims Submission. %%EOF We are committed to reducing stigma so no one is afraid to ask for help. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. If you have a question about . If you havent found what you need or have additional questions, press the button below to submit a general inquiry. Download information about our behavioral health solutions and public behavioral health overview. Healthcare providers may submit their requests for prior authorization of healthcare services to Magellan using the Texas Standard Prior Authorization Request Form for Health Care Services.. BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer. Box 710400, San Diego CA 921710400 Phone Number: (877) 263-9952 Blue Shield of CA: Payer ID: BS001 Claims Address: P.O. Paper Claims Address Independence Administrators P.O. Provider sends HIPAA transaction files directly to and receives responses from Magellan without a clearinghouse. You will be assigned an IT analyst to guide you through the process and address any questions. Services billed beyond 95 days from the date of service are not eligible for reimbursement. 1-713-663-1149 Utilization Management (Prior Authorizations), STAR Kids Referral and Authorization Process, Value-Added Services for STAR, CHIP and STAR Kids, Quality Improvements (QI) Toolkits and Tip Sheets, Home Delivery Pharmacy (Mail-Order Pharmacy), Medicaid (STAR) and CHIP Prior Authorization Forms, National Uniform Claim Committee (NUCC) 1500 Health Insurance Claim Form Reference Instruction Manual, Independent Review Organization (IRO) and EMR Provider Training, Interpreting the PLB Segment on the 835 ERA Guide. The EOP includes details of the payment or the denial. Blue Cross and Blue Shield of Texas. Blue Medicare HMO Blue Medicare PPO Contact: 1-888-296-9790 or. Magellans Primary Care Physician (PCP) Toolkit. Mailing Address, Customer Service and Claims Contact Information Line of Business Customer Service/ Telephone Number Address Blue Shield of CA (BSC)/ MHSA 1-877-263-9952 1-800-424-6064 1-800-424-5999, option 3 Claims Mailing Address Blue Shield of California Mental Health Service Administrator (MHSA) P O Box 710400 San Diego, CA 92171 Magellan Behavioral Health Providers! Open in Google Maps Business Hours. Its similar to the CMS 1500 claim form, with additional fields to make the application HIPAA-compliant. Enter your company name in the search box, select the group name from the drop-down, check the box at the bottom and then click the "Go" button. For the latest information on flexibilities and extensions due to COVID-19, refer to theTexas Medicaid & Healthcare PartnershipandTexas Health and Human Services Commissionwebsites. . 4 0 obj 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. Q. Blue Shield of California welcomes you. Because claims mailing addresses are different for different Blue Plan members, using the Claims Routing Tool is the most accurate way to determine a claims mailing address. Box 710400 . 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 Children's Health Insurance Program (CHIP), plans covering employees of the state of Texas, school districts, and the University of Texas and Texas A&M systems. 0 Human Resources . Email to submit provider inquiries and questions, Blue Cross and Blue Shield of Texas Email to submit provider inquiries and questions, Blue Cross and Blue Shield of Texas 1-361-878-1623 Visit our Help Center . To view this file, you may need to install a PDF reader program. 2022 Magellan Health, Inc. All Rights Reserved. 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). 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. Q. I have never had a claim denied for timely filing reasons before; why is it being denied now?A. Q. <>/Metadata 345 0 R/ViewerPreferences 346 0 R>> 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. Claims are paid based on your status on the date of service. 2 Magellan Pennsylvania provider data, July 2017-June 2018 Driving directions. See first question and answer above. 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. The State Health Benefits Program (SHBP) and the School Employees' Health Benefits Program (SEHBP) Program: 1-800-991-5579. You are responsible for verifying the member's coverage at the time of service. Make sure to send your claim form to the appropriate claims payer and specific address. 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. 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). Blue Cross Blue Shield of Arizona 2444 W Las Palmaritas Dr. Phoenix, AZ 85021 . Behavioral Health Services are provided byMagellan Health Services. Eligibility and benefits contact Availity or other electronic connectivity vendor or call 1-800-442-4607*, Behavioral health services mental health and chemical dependency prior authorization and referrals (includes inpatient, residential treatment center (RTC) programs, partial hospitalization and outpatient behavioral health services) call 1-800-528-7264, Behavioral health services claims status inquiries contact Availity or other electronic connectivity vendor or call 1-800-442-4607*, Behavioral health services claim adjustments call 1-800-442-4607, Eligibility and benefits contact Availity or other electronic connectivity vendor or call 1-877-299-2377*, Claim status inquiries contact Availity or other electronic connectivity vendor, Medical Management Correspondence for the Health Insurance Marketplace for Blue Advantage HMO Members, Blue Cross Blue Shield of Texas 9442 Capital of Texas Hwy N, Suite 500 BlueCross BlueShield of Tennessee is a Qualified Health Plan . endobj No. A. Complete the appropriate claim form - CMS-1500 forms are required for outpatient services and UB-04 forms are required for inpatient services. PO Box 660241 There are several reasons claims may not be paid upon their first submission. Utilization Management/Medical Management/Case Management. Phoenix Corporate Office Street Address. 1 Cameron Hill Circle . P.O. Magellan was the first MBHO to have a program included in this publication. Join Blue Cross and Blue Shield companies and leading voices from NAMI, Business Group on Health and Morgan, Lewis & Bockius LLP as they come together to discuss strategies for addressing pandemic-amplified behavioral health challengesparticularly as vaccines are rolling out and more focus on hybrid work models are set to spur workplace changes that can impact employee behavioral health. Box 7026 Wheeling, WV 26003 Wisconsin Anthem Blue Cross Blue Shield Phone: (800) 824-8839 Short-term claims for Blue Shield Life & Health Insurance Company Blue Shield Life & Health Insurance Company P.O. 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). <> Box 272640 Chico, Ca 95927-2640 Phone: (800) 541-6652 Fax: (818) 228-5014 View help topics or login via our member website. This claim is a resubmit; why was it denied for timely filing?A. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. 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. 195 0 obj <>stream 1001 E. Lookout Drive. Key Contact Information To view this file, you may need to install a PDF reader program. 1-512-349-4847 Horizon Behavioral Health. 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. There is a simple testing process to determine if Direct Submit is right for you. Dental Blue Book eManual; Dental Blue News; Dental Enrollment and Credentialing; x]rFwVa1)dJr#Qk%QKQ[93 yvk#Y _wOOOaxzXn&Wrru;8}N7o|Q2l1}e/_{12|qE2QPQ&/=d_W?F|)eAW+@y^n|"Gc9zOh Mail Claims or Claims Correspondence to: Blue Cross Blue Shield of Arizona P.O. In-network providers will be paid at their contracted rate. HealthChoiceswill notmake payments if the full obligations of the primary insurer(s) are not met. Claims must be submitted and received by us within 24 months after the service takes place to be eligible for benefits. Providers may continue to call Magellan with their prior authorization requests, as the form does not replace other existing methods of contacting Magellan to request a prior authorization. PDF File is in portable document format (PDF). Explore more about our programs and services addressing behavioral health, including substance use disorder treatment, and integration with physical health. Yes. Blue Cross and Blue Shield of Texas 1001 E Lookout Drive 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. Richmond, VA 23242 Member Services 1-800-521-6860 TTY: 1-800-684-5505 Representatives are available 24 hours a day, 7 days a week.. Read about our progress in the 2021 GuideWell Social Impact Report. *interactive voice response (IVR) system to access, you must have document control number (claim number), Blue Cross and Blue Shield of Texas Medicaid. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. % Click to skip to content, You are on secondary menu. Blue Shield Initial Appeal Resolution Office Attn: Hospital Exception and Transplant Team P.O. The ERA or ANSI 835 transaction is a HIPAA-compliant method of receiving claim payment and remittance details. 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. What should I do? BlueCare Tennessee is an Independent Licensee of the Blue Cross Blue Shield Association. 1998-BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the Blue Cross Blue Shield Association. TennCare is happy to provide you an email response to your inquiry. For service questions, such as benefits, claims, bill pay or other issues: Call: 1-800-495-2583, 8 a.m.-8 p.m . EDI Support: Contact Magellans EDI Hotline for support and/or assistance:1-800-450-7281ext. All Rights Reserved. Place of Service 23. Box 660044 endobj Box 805107, Chicago, IL 60680-4112. Pharmacy Claim. Fax: 972-766-2231 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. %PDF-1.7 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. Email to submit provider inquiries, Phone: 1-972-766-1380 BCBS Prefix List AAA to AZZ. BCBS Prefix List. Travel Benefit Claim. BCBS Customer Service Call the toll-free number on the back of your member ID card for BCBS customer service. Richardson, Texas 75082. Attention: Claim Department . Click to skip to content. Paper Pharmacy Claims: Send to: Attention Paper Claims Processing. 75890 or the EDI Support Mail Box:EDISupport@magellanhealth.com. $300 A Month Motel Dallas, Tx, Articles B
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