Frequently Asked Questions: Electronic Claims Submission
Q. Does Magellan accept electronic claims submission?
A. Magellan is now accepting electronic claims submissions for services normally submitted on a Form CMS-1500 and for institutional claims (normally submitted on a UB-04). We have contracts with several clearinghouses to facilitate electronic transactions, including claims processing for most accounts for which Magellan is the contracted claims payor.
Q. What are the benefits of electronic claims filing?
A. Electronic claims filing is much more efficient. You no longer have to keep track of or file paper claims, and you receive confirmation of receipt of your claim within one day of filing. You will also be promptly notified if a claim has not been completed properly for processing and payment.
Q. How can I submit electronic claims to Magellan?
A. Magellan providers have a couple of options for submitting electronic claims:
- A Web-based direct data entry claim submission tool on MagellanHealth.com. Professional claims typically submitted on a CMS Form 1500 can be submitted using this online tool.
- Contracted Clearinghouses. If your claims volume is large enough to make direct data entry cumbersome, or if claims for your services must be submitted on an institutional claim (UB-04), we encourage you to consider working with one of our preferred clearinghouses. If you already work with a clearinghouse, by advising them of the clearinghouses Magellan works with, your clearinghouse will likely be able to have your claims routed to us for payment.
Q. Will I be charged a fee to submit my claims electronically?
A. Magellan will not charge a fee for electronic claims submitted through our Web-based submission tool. However, our contracted clearinghouses do charge fees based on your ability to submit a HIPAA-compliant (X12) transaction. The fees charged by these clearinghouses are in addition to fees Magellan absorbs for each EDI transaction.
Q. Will Magellan continue to accept paper claims?
A. Yes. Paper claims will continue to be accepted.
Q. Are there HIPAA-compliant billing code requirements for electronic claims submissions?
A. Yes. All electronic claims submissions must include HIPAA-compliant billing codes (ICD-9-CM codes) in order to be processed.
Q. What if I already use a clearinghouse and it’s not the same as the clearinghouses that Magellan is using?
A. In order to submit electronic claims to Magellan, your clearinghouse would need to contact one of the Magellan clearinghouses to arrange to transmit the claims.
Q. Can a practice of any size file electronic claims?
A. Yes
Q. Can claims be filed electronically for all Magellan lines of business?
A. Most, but not all claims, for which Magellan is the payor can be received electronically. Specifically, Employee Assistance Program claims cannot be submitted to Magellan electronically.
Q. What do I need to do to file a claim electronically with Magellan?
A. To file a claim using Magellan’s Web-based direct data entry claim submission application, you will need to sign in to the provider page on MagellanHealth.com with your username and password. If you have never logged on to a Magellan provider website before, click on the New User link in the Sign-in box and follow the instructions on your screen to set up a username and password.
To file an electronic claim through a clearinghouse, you or your clearinghouse must contact one of the clearinghouses with which Magellan has arranged to receive electronic claims and arrange for your claims to be submitted to Magellan.
In order to send or receive electronic transactions with Magellan, including electronic claims, you will need your MIS number and the proper P.O. Box number to which you would submit a paper claim. Your MIS number can be found on your Explanation of Benefits (EOBs) and authorization of care letters from Magellan. If you are unable to locate your MIS number, you may request it by contacting our Provider Services staff at 800-788-4005.
Q. What should I do if my claim is rejected for payment?
A. Be sure to thoroughly read any reject notices you receive. If, after reading the reject notice you have questions, call the claims phone number on the notice for further clarification. Often the same error is submitted repeatedly resulting in repeated rejections. After reviewing the rejection notice, the claim should be corrected and re-submitted.
Q. What should I do if I receive a notice that my claim was accepted but then don’t receive payment?
A. If you receive a notice that Magellan accepted your claim, you can check the status of your claim through the Claims Inquiry application after logging onto the Magellan provider website.
Do not re-submit the claim as this will result in a claim denied as a duplicate and you may be subject to unnecessary clearinghouse charges.
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