EDI Now Available to Providers Submitting Less than 160 Claims Per Month
Magellan’s Electronic Data Interchange (EDI) Direct Submit Testing application, which is an electronic claims tool available on www.MagellanHealth.com/provider, now is available at no cost to all providers. Previously, this application was only available to providers submitting at least 160 claims per month.
You can use this application to send HIPAA transaction files directly to Magellan, allowing you to receive response files without the use of a clearinghouse. The HIPAA transaction files that Magellan currently supports include the 837P and 837I claims submission files. Files sent to Magellan will be validated, and if certification is granted, you will be permitted to submit claims files and receive responses.
Using this method for transmitting claims to Magellan allows you to:
- Use a secure method for transmitting claims
- Eliminate or avoid clearinghouse costs
- Submit multiple claims in batch mode
- Send files at any time – 24 hours a day, seven days a week.
Before you can submit files to Magellan, you must be a Magellan provider with an MIS number and NPI number. When you access the EDI Testing Center site, you will register for a new account, complete a survey and then submit test files. We will assign an IT analyst to support you during the process. You will be required to submit a minimum of two test files that successfully process and return response files before Magellan will permit submission of files to production (i.e., live claims processing).
We offer two alternatives for claims submission: PGP encrypted files via FTP and files sent through the website.
After successful submission of test files through the EDI Testing Center, Magellan will inform you that you are able to send production files. When sending HIPAA 837P and 837I transaction files, the Magellan preferred standard is one claim per ST/SE. If it is necessary for you to submit more than one claim per ST/SE, Magellan can typically accommodate this request.
A user guide including the process steps is available online. If you have any questions about the process, please contact us at EDISupport@MagellanHealth.com.