Frequently Asked Questions: Online Professional Claims Submission
General FAQS
Q. Does Magellan have an online claims submission application?
A. Yes, Magellan is now offering our providers a browser-based online claims submission application for professional services. Professional services include those services typically billed using a Form CMS-1500.
Q. What are the benefits of using the Online Professional Claims Submission application?
A. Electronic claim filing is more efficient and cost effective. You no longer have to keep track of or file paper claims, and you receive confirmation of receipt within one day of filing the claim. And best of all, filing online claims using the browser-based application is free to providers that have secure access to the Magellan provider website.
Q. What type of claims may be submitted using the on-line claims submission application?
A. Claims for services normally submitted on a CMS-1500 may be submitted using the online claims submission application.
Q. Are there claims that cannot be submitted using the Online Professional Claims Submission application?
A. Yes. Institutional claims for services normally submitted on a Form UB92, and Employee Assistance Program (EAP) claims cannot be billed using the online claims submission application. EAP claims require the submission of a standard Case Closing Form and institutional claims require additional information not currently available in the online professional claims submission application.
Q. Is there a charge to submit claims through Magellan’s Online Professional Claims Submission application?
A. No, this service is offered free of charge to Magellan providers who have secure access to the Magellan provider website.
Q. Is there something I have to load on my computer to use the Online Professional Claims Submission application?
A. No. Online claims submission is a browser-based application. You will only need to launch your Internet browser and log on to the Magellan provider website using your secure login and password.
Q. Can I submit my UB92 claims through Magellan’s online claims submission application?
A. Not at this time. Currently we are only accepting online claims for professional services normally submitted on a CMS1500.
Q. Will Magellan be accepting Web-based claims submission for institutional claims in the future?
A. Yes, Magellan is currently developing an online claims submission application for institutional claims.
Q. How can I access the online claims submission application?
A. You will need to log in to the website with your username and password to access the claims submission application. If you are currently a credentialed and contracted Magellan provider and you do not know your user name and password, click on the New User link in the Sign-In box on the Welcome Page. You will be required to accept a user agreement and provide some information about yourself and your practice. If the system fails to recognize you and does not return a login and password, please contact your Network Support Representative.
Q. Is the Online Professional Claim Submission application secure and HIPAA compliant?
A. Yes
Specific Application Questions
Q. Does the online claims submission application require any additional information not required on the CMS-1500?
A. Yes. A claim submitted through Magellan’s claims submission application must comply with HIPAA regulations. Therefore, there are extra fields which request information required by HIPAA for electronic claims submission.
Q. Do I have to enter something in every field?
A. You may. It depends on the type of claim you are submitting. The application will guide you through the required fields and a Help document is available for each field within the application.
Q. Why is the PO Box number required?
A. The PO Box number that you would normally mail your paper claims to is required to make sure your claim is processed correctly. If your claim does not include the correct PO Box number, your claim may be rejected.
Q. What is an MIS number?
A. An MIS number is the provider identification number assigned to you by Magellan.
Q. Why do I have to enter my MIS number?
A. Your MIS number allows Magellan to process your claim efficiently. The MIS number makes sure the claim is paid to the appropriate provider and at the appropriate rates.
Q. How do I find out what my MIS number is?
A. Your MIS number may be printed on your authorization letters or on a Magellan EOP statement. If you are unable to locate your MIS number, call the Provider Service line at (800) 788-4005 to request it.
Q. How do I submit a claim that lists more than one visit?
A. You may enter up to a total of six lines per claim on the online claims submission application.
Q. What are POS codes?
A. POS stands for Place of Service. Enter the location where the service was rendered in this field.
Q. What if I make a mistake?
A. If you are working on the page where the mistake occurred, you can click on the field and correct your entry. If you have proceeded to the next page, you will need to click on the progress bar at the top of the page to access the page with the mistake. If you began entering new information on a page that is not yet saved, and decide to access information on a previous page, you will be prompted to save the current page prior to moving to another page.
To cancel the claim before submission, click on the “Clear Form” button, or close your web browser. Once the “Submit” button is clicked, the claim submission cannot be stopped or corrected.
Q. What if I don’t have time to complete the claim?
A. You may save an incomplete claim by using the “Save for Later” button on the bottom of the page. You will need to complete the current page in order to use this feature since partially completed pages may not be saved.
Q. What if I can’t find what I want on a drop-down menu?
A. If the information you require is not on the drop-down menu, the claim must either be submitted using an EDI transaction through one of our contracted clearinghouses, or be submitted on paper. Please review EDI information for more information about our clearinghouses.
Q. How will I know if my claim is accepted for processing?
A. You will be given the option of printing your completed claim prior to submitting it. In addition, within 24 hours of submission of a claim, you can check to see whether it has been accepted for processing or rejected by clicking on “View Submitted Claims” within the claims submission application. If your claim was rejected, a reason is provided to help you correct the claim for resubmission.
Q. My claims have been rejected for “invalid diagnosis.” What diagnosis should I use?
A. Magellan requires HIPAA compliant codes. The online claim submission application requires HIPAA compliant ICD-9 codes. Please refer to our Code Sets for more information.
Q. My claims have been rejected for “invalid CPT codes.” What CPT codes should I use?
A. Magellan requires HIPAA compliant codes on all claims submissions. The online claims submission application requires HIPAA compliant CPT codes. Please refer to HIPAA compliant codes for more information.
Q. If I have any questions, is there someone I can contact and get help right away?
A. Yes. If you are not able to get your question answered through our online Help, click on the FAQ link and send a message with your question.
Q. How can I make a suggestion to Magellan regarding the claim submission application?
A. We welcome your feedback. To submit your suggestions, please contact us.