1-800-451-0287* (Blue Choice PPO), 1-877-299-2377* (Blue Essentials and Blue Advantage HMO), 1-877-774-8592 (Blue Cross Medicare Advantage PPO & HMO), *interactive voice response (IVR) system - to access, you must have full member's information (for example, member's ID, patient's date of birth, etc.). Box 91059 Seattle, WA 98111-9159 *Washington Regence Blue Shield P. O. This claim is a resubmit; why was it denied for timely filing?A. Behavioral Health Services are provided byMagellan Health Services. 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 View the 2021 GuideWell Social Impact Report. Box 312599 Detroit, MI 48231-2599. <> One option is Adobe Reader which has a built-in reader. Email to submit provider inquiries, Blue Cross and Blue Shield of Texas (BCBSTX). . PO Box 10191. From February 15 to September 30, on weekends and holidays, you may be required to leave a message. Winston-Salem, NC 27105. For status call: 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. Email to submit provider inquiries, Phone: 1-972-766-1380 San Antonio, TX 78257-8222 Q. Place of Service 22. Email to submit provider inquiries and questions, Blue Cross and Blue Shield of Texas Upon receipt of a claim, Magellan reviews the documentation and makes a payment determination. 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. 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. Where do I send the claim information?A. Dallas, TX 75266-0044, Behavioral health services - claims status inquiries, For services managed by BCBSTX: Blue Shield of California welcomes you. Fax 877-361-7646, Claims submission address: Fax: 361-852-0624 Phone: 1-972-766-7100 Beaumont, TX 77702-1954 Phone Numbers for Providers. Box 629011 El Dorado Hills, CA 95762-9011. Resubmitted claims should include the Date of Original Submission and Claim number if applicable. Eligibility and benefits 2615 Calder St, Suite 700 Richmond, VA 23242 Q. I have a specific question about a claim. Claims Submission. 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 Medicaid and CHIP Claim Editing Enhancements Coming Feb. 23, 2022, ICD -10 Z Codes for Social Determinants of Health, How to Submit a Complaint as a Medicaid Provider, Medicaid Provider Information on COVID-19 Coverage, Members can ask for an External Medical Review (EMR) and State fair Hearing from the state Medicaid program and get information about how the process works in our provider alert. <>/Metadata 147 0 R/ViewerPreferences 148 0 R>> 10 things to check each time you submit a claim: Q. I believe I am being paid the incorrect rate. Dallas, TX 75266-0044 Services billed beyond 95 days from the date of service are not eligible for reimbursement. 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. Complete the appropriate claim form - CMS-1500 forms are required for outpatient services and UB-04 forms are required for inpatient services. 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. BCBS Prefix List AAA to AZZ. BCBSTX makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. Box 7355 . 1 0 obj <> EAP providers can request an EAP authorization by leaving a brief voicemail message. Email to submit provider inquiries and questions, Ambulatory Surgery Centers (ASC) Independent, Non-Hospital owned, Fax: 1-713-663-1227 Click the link below to find the provider portal for your needs. If you havent found what you need or have additional questions, press the button below to submit a general inquiry. x]rFwVa1)dJr#Qk%QKQ[93 yvk#Y _wOOOaxzXn&Wrru;8}N7o|Q2l1}e/_{12|qE2QPQ&/=d_W?F|)eAW+@y^n|"Gc9zOh Magellan continuously looks at our processes and procedures to improve service and increase efficiencies. TO AVOID DELAY, DO NOT SUBMIT FORM TO MULTIPLE AREAS/OFFICES. EFT is a direct deposit claim payment from BCBSTX to your designated bank account. BCBS Prefix List - Alpha. Out-of-network providers will be paid the Medicare-allowed amount less any member cost-sharing. Check member eligibility, submit and check claims and find important information and more on our provider portal. Medicare Plus Blue SM PPO claims Blue Cross Blue Shield of Michigan P.O. Claims submission address: Blue Cross and Blue Shield of Texas P O Box 660044 Dallas, TX 75266-0044. HealthChoiceswill notmake payments if the full obligations of the primary insurer(s) are not met. Richardson, Texas 75082. 2. 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. 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 Mailing address (for paper claims): Blue Shield of California Mental Health Service Administrator (MHSA) P.O. Upon receipt of your message, New Directions will fax or mail you the . There are several reasons claims may not be paid upon their first submission. hb```@(]K@1% V!iD3 7+S#UBCm0#LiF j9vvfL4 q* Availity provides administrative services to BCBSTX. P.O. %%EOF 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. <> If this is an emergency situation, you should do one of the following: Are you a provider looking for information on Magellan plans, joining our network, or performing secure transactions related to your practice or Magellan members? Blue Shield 65 Plus (HMO): Blue Shield 65 Plus Medicare Provider Appeals Department P.O. El Paso, TX 79912 -6156 Users will obtain immediate feedback regarding the results of the test to ensure compliance with HIPAA rules and codes. . This new site may be offered by a vendor or an independent third party. Magellan Healthcare Solutions for Complex Care Needs: Behavioral Health, Specialty Imaging, Automated Prior Authorization, Employee Assistance. For urgent requests only: %PDF-1.5 % P O Box 660044 MagellansMedical Providers Behavioral Health Toolkitgives medical practitioners the information and screening tools needed to assist in making behavioral health referrals. It is important for you to stay current with your specific state and/or plan/program requirements. Blue Cross and Blue Shield of Texas Email to submit provider inquiries, 1001 E. Lookout Drive You should also check with your billing service, clearinghouse or software vendor to confirm ERA-compatibility and availability of auto-posting software. As a Magellan network provider, what is my timely filing limit?A. Customer Service. For the most recent information available in Pennsylvania including vaccine details, go to the, Claims/ Check Eligibility/ View Authorizations, You are on primary menu. 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. Houston, TX 77027-3279 Copyright 2022Health Care Service Corporation. General Information: 1-972-766-6900. 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. 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. Fax: 361-852-0624 (page_last_updated 03/2022) Fax: 972-766-2231 . Pharmacy Claim. Copy of EOP from the medical/health plan vendor substantiating their denial date. A Claims Courier Demo can be accessed at: Claims Courier is a free web-based data entry application. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Credentialing Status. Still looking for additional help? Magellan Healthcare is contracted to perform behavioral health managed care functions supporting members and participants for the following Blue Cross and Blue Shield of Texas HMO networks; Blue Advantage HMO SM, Blue Cross Medicare Advantage HMO SM, Blue Cross Medicare Advantage Dual Care (HMO SNP) SM and MyBlue Health SM. Claims must be submitted and received by us within 24 months after the service takes place to be eligible for benefits. This date is based on the date of the other carriers decision. <> This new site may be offered by a vendor or an independent third party. A. Bundling Rationale (Claims filed before Aug. 25, 2017) BlueCross BlueShield of Tennessee uses a clinical editing database. Human Resources . Registertoday with no set-up fees, monthly fees or per-claim fees charged to providers by visiting theAvaility websiteand selecting"Register". Box 2291 Durham, NC 27702-2291 . The ERA can be automatically posted to your patient accounting system. all_rights_reserved. Contact Us. Claims Submitting Claims Claims will continue to go directly to BlueCross. The form cannot be used for any other purpose except to request prior authorization of a healthcare service. If you have a question about . Fax: 512-349-4853 Apply for individual or family medical, dental, and life insurance plans. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. 75890 or the EDI Support Mail Box:EDISupport@magellanhealth.com. endstream endobj startxref Box 272640 Chico, Ca 95927-2640 Phone: (800) 541-6652 Fax: (818) 228-5014 Box 272540, Chico CA 959272540 Phone Number: (800) 541-6652 Is Blue Shield MHSA the same as Magellan? Looking to contact Magellan Rx Management? . 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. Predetermination form and DO NOT COMPLETE THIS FORM IF YOU ARE A MAGELLAN COMPLETE CARE MEMBER OR PROVIDER. Key Contact Information 4444 Corona, Suite 148 BlueCross BlueShield of Tennessee payer ID number: 00390. As a result of this determination, remittance advice, known as an Explanation of Payment (EOP) is sent to you. Magellan Behavior Health Services coordinates all behavioral health (mental health and chemical dependency) services for Medicaid (STAR), CHIP, and STAR Kids members. For this reason, your resubmitted claim has been denied. Care Management Contact Information . Mail Claims or Claims Correspondence to: Blue Cross Blue Shield of Arizona P.O. EDI Support: Contact Magellans EDI Hotline for support and/or assistance:1-800-450-7281ext. Fax: 713-663-1227 Montgomery:(877) 769-9782 Northampton:(866) 238-2312 Provider Services Contact Information: Bucks/Montgomery: (877) 769-9779 Cambria:(800) 424-3711 Lehigh/Northampton:(866) 780-3368 Information For Members & Providers: TTY (All counties):PA Relay 7-1-1 Fraud & Abuse:(800) 755-0850 For Emergency Situations, Always Call 911 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. 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. This new site may be offered by a vendor or an independent third party. Make sure to send your claim form to the appropriate claims payer and specific address. Member Questions Blue Cross Blue Shield members, please contact your BCBS company if you have specific questions about your plan, coverage and more. 1 Magellan Behavioral Health of Pennsylvania evaluation including claims data, the Consumer Health Inventory survey, and housing and income data For service questions, such as benefits, claims, bill pay or other issues: Call: 1-800-495-2583, 8 a.m.-8 p.m . The EOP includes details of the payment or the denial. Call 911. For preauthorization of psychological testing, in addition to the Texas Standard Prior Authorization Request Form for Health Care Services, Magellan also requires the provider to complete and submit the Request for Psychological Testing Preauthorization form found on our clinical forms page. Availity provides administrative services to BCBSTX. Find plan-specific and program resourcesfor Texas STAR, STAR Kids and CHIP. 0 You will be assigned an IT analyst to guide you through the process and address any questions. Visit our Help Center . *interactive voice response (IVR) system to access, you must have document control number (claim number), Blue Cross and Blue Shield of Texas Medicaid. TennCare Pharmacy Program 1-888-816-1680. Resubmissions must be submitted within 60 days from the date of denial. Q. In addition, some sites may require you to agree to their terms of use and privacy policy. Blue Shield Final Appeal Resolution Office P.O. 1-361-878-1623 Claim forms must be submitted to: Blue Cross and Blue Shield of Alabama. Sign up to receive information and updates from Magellan Healthcare on behavioral health webinars and education! 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 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. Box 629010 El Dorado Hills, CA 95762-9010. Outside the United States. Magellans PCP toolkit represents Magellans commitment to promote integration of medical and behavioral health services toward the goal of better overall outcomes for patients. Skip to article content, Intensive care coordination for members with serious mental illness (SMI) and comorbid conditions, Family-based, value-based care for children and adolescents at risk for hospitalization or out-of-home placement, Targeted case management for homeless individuals with SMI, Integrated case management through our Dual-Diagnosis Treatment Team for individuals with developmental disabilities, Digital cognitive behavioral therapy supporting increased screening and online treatment for pain management, substance use, depression, anxiety and insomnia, Increased access to medication-assisted treatment (MAT), Peer support and recovery and resiliency services focusing on members development and achievement of health and wellness goals, and connection to community resources, Communication campaigns and resources, providing guidance for members and providers in a variety of convenient formats, Internal policies and procedures to reinforce coordination throughout the care management process, Mutual cooperation and coordination agreements to share clinically relevant information. P. O. 1-915-496-6600, press 2 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. 1-512-349-4847 Birmingham, Alabama 35244-2858. Medicaid Network Management Email to submit provider inquiries and questions. 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). Q. I have proof that I submitted the claim within the timely filing limits. Submit appeals within 120 calendar days from receipt of remittance advice (RA). (out-of-state subscribers) San Diego, CA 92171 . 4 0 obj . stream Behavioral Health Services: 1-800-266-6167. This new site may be offered by a vendor or an independent third party. Again, this can be a huge time-suck, calling and being transferred over and over. 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