Outside the United States. The following items when submitted with your appeal may be considered evidence that your claim was submitted in a timely manner: Q. The toolkit includes coverage and reimbursement options for postpartum depression through Medicaid, CHIP, the Healthy Texas Women Program, the Family Planning Program and other referral options. Corpus Christi, TX 78411-4375 BlueCard is our out-of-area program that allows members from other Blue Cross and Blue Shield Plans to receive health care benefits when travelling or residing in another Blue Plan's service area. Predetermination form and The short answer is yes! *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*. 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. Behavioral Health Services are provided byMagellan Health Services. 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. <> Fax: 713-663-1227 You may direct any questions about the form to Magellan at the phone number on the form. Magellans PCP toolkit represents Magellans commitment to promote integration of medical and behavioral health services toward the goal of better overall outcomes for patients. Fax: 972-766-2231 PDF Magellan Complete Care Provider Quick Guide Payers with unique claim filing rules - SimplePractice Support Blue Cross Blue Shield of Illinois is the location of the claims processing center and customer service center. EAP providers can request an EAP authorization by leaving a brief voicemail message. One option is Adobe Reader which has a built-in reader. In-network providers will be paid at their contracted rate. 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. Registertoday with no set-up fees, monthly fees or per-claim fees charged to providers by visiting theAvaility websiteand selecting"Register". ~_IV21b~Lj Find plan-specific and program resourcesfor Texas STAR, STAR Kids and CHIP. Fax: 915-496-6614 BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer. endstream endobj startxref 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. TTY: 735-2989. This new site may be offered by a vendor or an independent third party. Federal Employee Program claims Blue Cross Blue Shield of Michigan P.O. 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. Read about our progress in the 2021 GuideWell Social Impact Report. 136 0 obj <> endobj Horizon Behavioral Health. Services billed beyond 95 days from the date of service are not eligible for reimbursement. Explore more about our programs and services addressing behavioral health, including substance use disorder treatment, and integration with physical health. 2022 Magellan Health, Inc. All Rights Reserved. Therefore it does not support revenue codes (codes submitted on 837I files or a UB-04). Fax: 1-713-663-1227 What should I do? Magellan has separate post office boxes for the accounts for which we provide claims payment services. 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). In accordance with applicable law, Magellan will pay clean claims within 45 days of the date of receipt. 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. As a Behavioral Health-Managed Care Organization (BH-MCO), Magellan manages members' benefits in coordination with you - our network providers. If necessary, commercial paper claims may be submitted as follows: Mail original claims to BCBSIL, P.O. Will the timely filing standards be applied to claims I submitted prior to being a Magellan provider?A. . 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. Most people don't view their physical and mental health as separate, and neither do we. 9~zfH. Connect with us about any general, media or sales inquiries. 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. Eligibility and benefits Most PDF readers are a free download. <>/Metadata 345 0 R/ViewerPreferences 346 0 R>> As a Magellan provider, you are required to hold HealthChoices members harmless and cannot bill them for the difference between your contracted rate with Magellan and your standard rate. Upon receipt of the completed form(s), Magellan will begin the prior authorization process. <>/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>> Its similar to the CMS 1500 claim form, with additional fields to make the application HIPAA-compliant. Dallas, TX 75266-0044 There are several reasons claims may not be paid upon their first submission. 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. Fax: 512-349-4853 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. Magellan Behavioral Health Providers of Texas, Inc. Request for claim review form and instructions, Wellness and clinical practice guidelines, Independent Diagnostic Testing Facility (IDTF), Intensive Outpatient facility programs (PHP/IOPs). 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. (See item #2 below to learn how to contact your BCBS company to address any errors.) Fax: 713-663-1227 Pharmacy claim submission and Pro- DUR questions ; 24 hours / 7 days a week; Magellan Rx Management Pharmacy Call Center: 1-800-424-5725. Blue Shield Final Appeal Resolution Office P.O. 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. Find your provider portal Blue Cross Complete claims P.O. Together, we're committed to making a meaningful difference in the health of all Floridians. Magellan Behavioral Health Providers! 2 Magellan Pennsylvania provider data, July 2017-June 2018 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. Claims Address. If you need to mail claims: Horizon BCBSNJ. For prior authorization and referrals managed by Magellan: Magellan Behavioral Health Providers of Texas, Inc. 1-800-729-2422: Behavioral health services - claims status inquiries. 4 0 obj %PDF-1.7 BCBS Customer Service Call the toll-free number on the back of your member ID card for BCBS customer service. Blue Cross and Blue Shield of . It is important for you to stay current with your specific state and/or plan/program requirements. 450 Riverchase Parkway East. PDF File is in portable document format (PDF). Maryland Heights, MO 63043 . Log into the Availity Provider Portal, select Payer Spaces from the top navigation menu and select BCBSTX. For Texas-specific ABA resources,sign into this website. 1 Magellan Behavioral Health of Pennsylvania evaluation including claims data, the Consumer Health Inventory survey, and housing and income data Vision/Hearing Claim. 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 We're here to help answer your questions. Bundling Rationale (Claims filed before Aug. 25, 2017) BlueCross BlueShield of Tennessee uses a clinical editing database. Fax 877-361-7646, Claims submission address: When your BCBS ID card arrives in the mail, take a moment to look for these five things: 1. If necessary, government programs paper claims may be submitted. Still looking for additional help? Behavioral health benefits are integrated into Anthem medical plans for a full spectrum of coordinated care for our members. If you still need to submit paper claims, use the Claims-Routing Tool to determine the correct mailing address for each member. This new site may be offered by a vendor or an independent third party. Similar behavioral health programs are implemented across product lines but may differ by product. 75890 or the EDI Support Mail Box:EDISupport@magellanhealth.com. It is important to note that depression can occur during pregnancy as well as after the baby is born. You are leaving this website/app (site). Please emailwomenshealth@hhsc.state.tx.uswith any questions. Fax: 361-852-0624 These members enjoy the same level of coverage as other Medicare Advantage members with no network restrictions. 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. . Magellan continuously looks at our processes and procedures to improve service and increase efficiencies. 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 Please provide the Tax Identification Number, NPI, and if applicable, Medicare Numbers for your provider when contacting Network Management. endobj Customer Service: If you have questions or need additional support, BCBSTX Personal Health Assistants are available to 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 Mail Claims or Claims Correspondence to: Blue Cross Blue Shield of Arizona P.O. and the amount . DO NOT COMPLETE THIS FORM IF YOU ARE A MAGELLAN COMPLETE CARE MEMBER OR PROVIDER. Select the best option and fill out a form and we will reach out to you as soon as possible! Email to submit provider inquiries. TennCare Provider Services 1-800-852-2683. In addition, some sites may require you to agree to their terms of use and privacy policy. 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. hbbd```b``A$ There, claims submission information is broken out by prefix/product name. 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. Molina Healthcare Phone Number claims address of Medicare and Medicaid. Typically, a fee is attached by the clearinghouse vendor. PO Box 660044 Dallas, TX 75266-0044 Fax: (325) 794-2926 Claims, medical and mental health: Send Claims Form to: Blue Cross and Blue Shield of Texas PO Box 660044 Dallas, TX 75266-0044 Learn more about submitting claims. Box 85042. Availity EFT & ERA Enrollment User Guide. Box 660044 TO AVOID DELAY, DO NOT SUBMIT FORM TO MULTIPLE AREAS/OFFICES. For urgent requests only: 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 new Texas Clinicians Postpartum Depression Toolkit is intended to be a resource for Texas clinicians on screening, diagnosis and treatment of postpartum depression. The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. Box 805107, Chicago, IL 60680-4112. Please select the appropriate version of the form below based on the members you serve. Email: RxNetworksDept@magellanhealth.com. Phone Numbers for Providers. Magellan steps in for our members to help prevent and address the risks of one affecting the other. See first question and answer above. We really moved forward together., -Magellan Behavioral Health of Pennsylvania (HealthConnections) member. General Member Service Correspondence. This is the customer service number for questions about your health insurance coverage, benefits or treatment. Clean claims are defined as claims that can be processed without obtaining any additional information from the provider or from a third party. Paper Pharmacy Claims: Send to: Attention Paper Claims Processing. %PDF-1.7 If you havent found what you need or have additional questions, press the button below to submit a general inquiry. This practice is called balance billing and is not permitted. To view this file, you may need to install a PDF reader program. Skip to article content, Electronic Data Interface (EDI) via Direct Submit, Claims Courier-Magellans Web-based Claims submission tool, Paper Claims: CMS-1500 (Non-Facility-Based Providers) or UB-04 (Facility-Based Providers). Q. I have never had a claim denied for timely filing reasons before; why is it being denied now?A. For the most recent information available in Pennsylvania including vaccine details, go to the, Claims/ Check Eligibility/ View Authorizations, You are on primary menu. Claim status inquiries (out-of-state subscribers) contact Availity or other electronic connectivity vendor. 1 Cameron Hill Circle . % 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.) The process typically takes about 3 to 4 weeks to complete the process, so allow ample time to complete your independent testing. *interactive voice response (IVR) system to access, you must have document control number (claim number), Blue Cross and Blue Shield of Texas Medicaid. 3 Magellan of Virginia NCQA Quality Improvement Activity Form, 2018. Click the link below to find the provider portal for your needs. You are on primary menu. Click to skip to content, You are on secondary menu. In addition, some sites may require you to agree to their terms of use and privacy policy. 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 patricia.arredondo@franciscanalliance.org; . <> View the 2021 GuideWell Social Impact Report. You can download the toolkithere. Blue Cross and Blue Shield of Texas. Florida Blue is a part of the GuideWell family of companies. Call 911. Effective 6/27/2022, a Behavioral Health Service Coordination can help members manage complex conditions related to mental health and substance use. Blue Cross and Blue Shield of Texas 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 UB-04 claims Blue Cross Blue Shield of Michigan P.O. (336) 774-5400. View help topics or login via our member website. Email to submit provider inquiries and questions, Blue Cross and Blue Shield of Texas 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. Or call your doctor or therapist for help. Main telephone number 1-215-937-8000. Box 310166 Detroit, MI 48231-0166. 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. Box 7355 . . The easiest way to determine your current rates is to review the current rate sheet for your Magellan or affiliate company agreement. Blue Shield 65 Plus (HMO): Blue Shield 65 Plus Medicare Provider Appeals Department P.O. 195 0 obj <>stream Government Programs Claims Electronic claim submission is preferred, as noted above. You should also check with your billing service, clearinghouse or software vendor to confirm ERA-compatibility and availability of auto-posting software. Open in Google Maps Business Hours. The ERA or ANSI 835 transaction is a HIPAA-compliant method of receiving claim payment and remittance details. all_rights_reserved. One option is Adobe Reader which has a built-in reader. 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. endobj Email to submit provider inquiries and questions, Blue Cross and Blue Shield of Texas There is a simple testing process to determine if Direct Submit is right for you. Birmingham, Alabama 35244-2858. External link You are leaving this website/app (site). Box 7026 Wheeling, WV 26003 Wisconsin Anthem Blue Cross Blue Shield Copy of EOP from the medical/health plan vendor substantiating their denial date. endobj If you are able to create an 837 file in a HIPAA compliant format, we. 3 0 obj Dental Expense Claim. Or call your doctor or therapist for help. Medical Care Management %PDF-1.5 % Yes. By telephone. External link You are leaving this website/app (site). 1800 West Loop South, Suite 600 Appeals address: Blue Cross and Blue Shield of Texas Attn: Complaints and Appeals Department PO Box 660717 Dallas, TX 75266-0717 Fax 1-855-235-1055 Email GPDTXMedicaidAG@bcbsnm.com Availity - Submit Claims Appeal Form Online Log into the Availity Provider Portal, select Payer Spaces from the top navigation menu and select BCBSTX. When submitting claims electronically, the Magellan submitter ID is 01260. endstream endobj 137 0 obj <. Submit appeals within 120 calendar days from receipt of remittance advice (RA). BlueCare / TennCare Select Claims Service Center 1 Cameron Hill Circle, Suite 0002 Chattanooga, . 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. For status call: Keystone First 200 Stevens Drive Philadelphia, PA 19113. Place of Service 22. P O Box 660044 Resubmissions must be submitted within 60 days from the date of denial. 1-361-878-1623 Box 211184 Eagan, MN 55121 From 2015 to 2017, our programs contributed to a 26% increase in members who were asked by their behavioral health providers to authorize communication with their PCP providers.3, Working with HealthConnections, the team helped get me to a place of not having fear, not having pain, exercising and doing yoga. 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. Enforcing this clause also brings us in line with industry practices. 114 Mesa Park Dr. Suite #300 2615 Calder St, Suite 700 hb```@(]K@1% V!iD3 7+S#UBCm0#LiF j9vvfL4 q* Behavioral Health Services: 1-800-266-6167. 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. Copyright 2022Health Care Service Corporation. One option is Adobe Reader which has a built-in reader. Become an Anthem provider and join the nation's second- largest health plan-owned behavioral health company, serving more than 13 .
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