Claims Today
Claims Tips
Include NPI on Paper Claims
TIP: NPIs are required on electronic claims, but the NPI also should be included on paper claims for best results.
- Although the National Provider Identifier (NPI) is only required on electronic claims at this time, it provides information that also can be used to help process paper claims quickly and accurately.
- The NPI is useful on paper claims as an additional tool to help locate your provider record in our claim system.
- On the CMS-1500 form (version 08/05), insert billing Type 2 NPI in Box 33a; insert service facility Type 2 NPI (if different from billing NPI) in Box 32a; insert Type 1 NPIs for rendering providers in Box 24J.
- For an overview and additional information on NPI, visit the CMS Web site. Magellan also has posted Frequently Asked Questions about NPI on this website. Our NPI Claims Tips provide specific details on how to prepare and submit HIPAA-compliant claims.
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 Web site for more information.
- EFT is quicker and more reliable than the standard process of mailing checks.
Reducing Denials for Timely Filing
TIP: Do not delay - submit your claims early!
By following a couple simple steps, you can greatly reduce the chance of receiving a timely filing denial. The first step is as easy as submitting your claims early. The earlier you submit the claim, the more time you have to make any necessary resubmissions. The second step is to verify the correct claims address and member ID number on the member’s insurance card to ensure that the claim is sent to the correct address. If a claim is not received, it will not be considered to be a timely submission.
If you submit electronic claims, be sure to reconcile rejected claims as soon as possible. Rejected claims are not considered “clean claims” and a resubmission will be denied if it does not meet timely filing requirements. In order to allow sufficient time to reconcile any claims that may reject before they pass to the claims system, it is best to submit claims promptly.
Appropriate Proof for Appealing Timely Filing Denials
TIP: If a claim is denied for being submitted beyond the timely filing deadline, appeals should include proof of the claim’s timely submission.
To appeal Magellan’s timely filing denial, you may submit any of the following items for consideration:
- Copy of a Magellan Explanation of Payment (EOP) with a date within the filing standard
- Copy of a letter/correspondence from Magellan with a date within the filing standard
- Certified or overnight mail receipts dated within the filing standard
- Facsimile confirmation showing you faxed the claim to the correct claims address with imprinted dates within the filing standard
- Copies of the microfilmed claim with Magellan’s date stamp within the filing standard
- Copy of second-level EDI 277 acceptance reports (997 acknowledgements are not acceptable because they are given only when the claim goes through the HIPAA and companion guide edits. The claim may be rejected before it is accepted into the claim system. The 277 response is issued when the claim is actually accepted into the system.)
- Copy of EOP from the medical/health plan vendor substantiating their denial date.
Member Eligibility
TIP: Verify the member’s information before you submit your claim.
Magellan provides services for millions of members. To make sure your claim is matched with the correct member, please validate full name, birth date, identification or Social Security Number and correct address for both the member and the subscriber. After signing in with your secure username and password on this website, click “Check Member Eligibility” to verify member information prior to submitting the claim. Ensure 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).