Claims Tips
Resubmitting Rejected Electronic Claims
TIP: When resubmitting rejected claims, do not mark them as “corrected claims.”
- An electronic claim that does not pass to a claim payment system is rejected. Examples of why a claim would reject include: provider is not found, member is not found, incorrect PO Box number is used, or more than one rendering provider submitted on a claim. Rejected claims that are revised and resubmitted are not considered to be "corrected claims" because the original claim was never adjudicated in the claim payment system.
- An electronic claim that is denied was passed to a payment system, but was not payable for a number of reasons, including, but not limited to: member being ineligible, benefit is not covered, or benefit maximum has been met.
- A rejected claim must be researched differently than a denied claim. Direct your questions regarding rejected claims to your clearinghouse. Direct your questions regarding denied claims to the Magellan customer service line.
Provider Information on Electronic Claims
TIP: Verify that the TIN, NPI, name, and address on the claim matches Magellan’s system.
- The Magellan claim system is configured to match provider information on electronic data interchange (EDI) claims to the correct provider record in our system. This process allows claims to process quickly and accurately.
- In order to match an EDI claim to the correct provider record, the Taxpayer Identification Number, National Provider Identifier (NPI), name, and address must match the information in Magellan’s claim system.
- To help avoid issues, please do not abbreviate, and be careful to use the correct letter/number (e.g., do not substitute the letter “O” for zero).
- If the system cannot find a match, the claim may reject. If the system attaches to an incorrect record because incorrect or incomplete information was submitted, then the claim may take additional time to process.
- If you have any questions about how to submit your provider information on electronic claims, please contact our Provider Services Line at 1-800-788-4005 for assistance. We can verify your information to help prevent delays in claim processing.
Keep Your Mailing Address Information Current
TIP: Help us protect members’ personal health information (PHI) by always billing with your current mailing address.
- If your mailing address has changed, please notify Magellan immediately, or update your information on this website via the Display/Edit Practice Information application, so that we can update our system accordingly.
- Do not submit a claim with your previous mailing address, even if you expect the mail to be forwarded. If the mail is delivered to the old address, it could be opened by someone else, exposing the member’s PHI.
