Claims Tips
Electronic Funds Transfer
Tip: Receive your payments electronically – it’s simple, fast and efficient.
Take advantage of Magellan’s Electronic Funds Transfer (EFT) for claims payments.
- You can request to have certain claims payments directly deposited to your business bank account. See the “Getting Paid” area of our website for more information.
- EFT is quicker and more reliable than the standard process of mailing checks.
Submitting payment information from a primary insurer
TIP: Make sure the copy of the primary carrier’s EOB is complete and legible.
- When another insurer has primary payment responsibilities, you must submit a complete and legible copy of their insurance statement with paper claims.
- Do not highlight on the primary insurance statement. Highlighting can make the statement difficult to read.
- Ensure that all information pertaining to the member’s claim is included on the copy. If just one portion of the member’s statement is cut off, we may not be able to calculate secondary benefits.
License Level of Rendering Provider
TIP: Magellan needs the license level of the provider rendering service.
Magellan organizational providers and individual providers billing with an organization’s Taxpayer Identification Number (TIN) should bill with the appropriate modifier (PDF) to represent the rendering provider’s license level.
Insert HIPAA modifiers on the claim forms:
- On a CMS-1500 form, insert the modifier in Field 24d under “Modifier.”
- On a UB-04 form, insert the modifier with CPT or HCPCS code in field 44 (e.g., “90801 AH”).
Member Eligibility
Tip: Verify the member’s information before you submit your claim.
Magellan provides services for millions of members. Please follow these steps in order to make sure that your claim is matched with the correct member.
- Validate the full name, birth date, identification or Social Security Number, and correct address for both the member and the subscriber.
- Use the “Check Member Eligibility” function on this website, after signing-in with your secure username and password, to verify member information prior to submitting the claim.
- Ensure that you’re not replacing zeros with the letter ‘O’ (00140 not OO14O) or using a nickname rather than the member’s policy name (Cindy vs. Cynthia).