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Submitting Electronic Transactions/Claims to Magellan

Electronic transactions, including claims submitted to Magellan, must be HIPAA compliant so that member confidentiality is maintained. This Web page provides numerous tools and resources to assist you in preparing to send to and receive electronic communication from Magellan. Please evaluate and take advantage of one of the electronic methods available to you for submitting your claims quickly and easily. All of Magellan’s claims tools are designed to save you time and eliminate paperwork burden while supporting accurate, timely claims payment.

1. Claims Courier

Accessible via this Magellan provider website, Claims Courier is a Web-based data entry application for providers submitting professional claims on a claim-at-a-time basis. You can gain access to Claims Courier by signing onto the site with your username and password, and following the instructions for “Submit a Claim Online.” Claims Courier streamlines the claims process by eliminating the claims middleman, and there is no charge to you for using the service. You simply data enter your claims information into the online Claims Courier application. Note that Magellan must be the designated payer in order to process your submitted claims.

On the main Claims Courier (Submit a Claim) page, you can:

  • Create a new, blank claim
  • Create a new claim from a copy of a previously submitted claim
  • Complete a claim you saved previously
  • View your submitted claims.

2. Direct Submit

Through this Magellan application, HIPAA-compliant 837 files can be sent directly to Magellan in bulk, without accompanying claim data entry or the involvement of a clearinghouse. Direct Submit is available to all providers regardless of claims submission volume. There is no charge to you for using the service.

To get started on the process, visit our EDI Testing Center website at www.edi.MagellanProvider.com. The center offers an easy-to-follow, six-step process to independently validate your EDI test files (837 Professional and Institutional) for HIPAA compliance rules and codes. You will be assigned an IT analyst to guide you through the process and address any questions. The process includes creating your unique user ID and password, downloading EDI guideline documentation (companion guides), uploading and testing EDI files, and obtaining immediate feedback regarding the results of the validation test. Once you have completed the six-step process, you will be able to exchange production-ready EDI files with Magellan.

You can register to submit EDI claims to Magellan by sending an email to EDISupport@MagellanHealth.com or by contacting Magellan EDI Support at 1-800-450-7281, extension 75890.

3. Clearinghouses

External EDI clearinghouses act as a middleman between the provider and Magellan, and can transform non-HIPAA-compliant formats to compliant 837s. Magellan accepts 837 transactions from a number of clearinghouses. Note that there may be charges from the clearinghouses. Review the clearinghouse contact information.

Companion Guides

The Magellan Companion Guides provide detailed instructions on exchanging HIPAA compliant ASC X12N transactions with Magellan. The documents are designed for the technical departments or areas responsible for submitting electronic transactions to Magellan. However, the business rules within these guides are to be communicated to and coordinated with the appropriate departments responsible for the capture or generation of any data required in the HIPAA standard transactions.

Magellan Standard Companion Guides include information regarding:

  • Working with Magellan
  • Connectivity
  • Contact information
  • Control segments
  • Magellan business rules
  • Acknowledgments
  • Testing

The transaction-specific Companion Guides (click on the Public Resources tab at www.edi.MagellanProvider.com) include Magellan's business rules specific to the individual type of transaction.

Additional Information