Claims Today
Claims Tips
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 should 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, secondary benefits may not be able to be calculated.
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 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”).
Don’t Miss Timely Filing Deadlines
TIP: An electronic claim must pass validation before it is considered “received.”
- It is critical to regularly check for and reconcile rejected claims to avoid missing timely filing deadlines.
- All electronic claims – regardless of the method of submission (clearinghouse, Direct Submit, Claims Courier, etc.) – must pass through a validation process in order to be considered a “received” claim. Claims that do not pass validation will be rejected without being processed.
- It is important to allow several days for the claim validation process.
- Timely filing is determined by the number of days between the “received” date and the date of service.