Claims Today
Claims Tips
Inclusive Versus Exclusive Fees on Facility Claims
TIP: Contact the facility for payment if services are denied as being “included in the per diem rate”
In order to submit your claim for professional fees to the appropriate entity, it is important to know whether the Magellan agreement with the facility is inclusive or exclusive. The Magellan facility provider agreement specifically includes (inclusive) or excludes (exclusive) professional fees associated with per diem charges.
Providers who submit a claim for services rendered in a facility with an inclusive agreement with Magellan will receive the following denial: “Reimbursement for these charges is included in the facility per diem rate.”
If you receive this denial message, please contact the facility for payment.
Don’t Forget About the EDI Direct Submit Application
TIP: Application is available to all providers, even those submitting less than 160 claims per month
- Magellan’s Electronic Data Interchange (EDI) Direct Submit application is an electronic claims tool available on this website 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 application is a secure method for transmitting claims that eliminates clearinghouse costs.
For additional information on the EDI Direct Submit application, please see the previous article on this topic.
Reducing Duplicate Denials on Electronic Claims
TIP: Repeat claim submissions are not necessary to receive a prompt response
- Some providers are submitting electronic claims within a week of the original submission.
- Please be assured that we process claims in date order starting with the oldest claims, so resubmitting the same claim within a few days of the original submission will result in a duplicate claim denial.
- If 30 days have passed without a response, verify that the electronic claim was not rejected before being passed to the claim payment system. If the claim was not rejected, contact your customer service group to check on claim status.