To view this file, you may need to install a PDF reader program. * (Blue Essentials and Blue Advantage HMO), Prior Authorization Services For Fully Insured and ASO, Prior Authorizations Lists for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO), Prior Authorizations Lists for Designated Groups, Prior Authorization Exemptions (Texas House Bill 3459), Medicare Advantage Private Fee-for-Service (PFFS), Eligibility and Benefits Inquiry (HIPAA 270/271), Behavioral Health Care Management Program, Quality Care Partner With Your Patients, Preventive Care Guidelines/Patient Wellness Guidelines, Health Equity and Social Determinants of Health (SDoH), Prescription Drug List and Prescribing Guidelines, Prior Authorization and Step Therapy Programs, Medical Policy and Pre-certification/Pre-authorization Information for Out-of-Area Members, Consolidated Appropriations Act and Transparency in Coverage Final Rule, Email to submit provider inquiries and questions. Behavioral health benefits are integrated into Anthem medical plans for a full spectrum of coordinated care for our members. Email to submit provider inquiries and questions, Blue Cross and Blue Shield of Texas However, if a provider wishes to request a prior authorization by mail or fax using a form, it must be this form as prescribed by the Texas Department of Insurance. Outside the United States. Resubmitted claims should include the Date of Original Submission and Claim number if applicable. Box 312599 Detroit, MI 48231-2599. 0 For urgent requests only: TennCare Provider Services 1-800-852-2683. View help topics or login via our member website. Our approach addresses the most costly areas and most unique needs of health plans, fueling discovery of unmet clinical needs and driving innovation to improve health and financial outcomes. Magellan has had sites accredited by URAC since 1992. Similar behavioral health programs are implemented across product lines but may differ by product. For Texas-specific ABA resources,sign into this website. The site may also contain non-Medicare related information. If this is an emergency situation, do one of the following: Call 911, go directly to an emergency room, or call your doctor or therapist for help. This new site may be offered by a vendor or an independent third party. 1001 E. Lookout Drive 9442 Capital of Texas Hwy N, Suite 500 800-676-BLUE (2583). EAP providers can request an EAP authorization by leaving a brief voicemail message. Box 805107, Chicago, IL 60680-4112. Attn: Predetermination Dept. Mail your payment to the address on your premium invoice or learn about other convenient ways to pay your bill. Customer Service: If you have questions or need additional support, BCBSTX Personal Health Assistants are available to help. Claims are paid based on your status on the date of service. If you believe your claim was denied in error, please send your request to the appeal submission address found on the Explanation of Payment (EOP). BCBS Prefix List - Alpha. The short answer is yes! One option is Adobe Reader which has a built-in reader. Contact Us. BlueCare / TennCare Select Claims Service Center 1 Cameron Hill Circle, Suite 0002 Chattanooga, . Medicare Plus Blue SM PPO claims Blue Cross Blue Shield of Michigan P.O. Connect with us about any general, media or sales inquiries. Box 21974 Eagan, MN 55121 1-800-778-2119 Verify eligibility and benefits at 1-888-356-7899 www.pearprovider.com Independence Blue Cross Federal Employee Program (FEP) PPO "R" followed by 8 numeric characters 54704 837I - 12X26 Facility Providers Claims 1Only Claims Receipt Center Driving directions. Member Services 1-800-521-6860 TTY: 1-800-684-5505 Representatives are available 24 hours a day, 7 days a week.. Claim status inquiries contact Availity or other electronic connectivity. San Diego, CA 92171 . Richmond, VA 23242 Box 2924 Phoenix, AZ 85062-2924. . Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. Resubmission of Claims: Claims that must be revised and resubmitted after adjudication must be stamped resubmission or otherwise noted on box 22 of the CMS-1500 form. . Visit our Provider Portals English 1998-BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the Blue Cross Blue Shield Association. One option is Adobe Reader which has a built-in reader. See first question and answer above. Skip to article content, Intensive care coordination for members with serious mental illness (SMI) and comorbid conditions, Family-based, value-based care for children and adolescents at risk for hospitalization or out-of-home placement, Targeted case management for homeless individuals with SMI, Integrated case management through our Dual-Diagnosis Treatment Team for individuals with developmental disabilities, Digital cognitive behavioral therapy supporting increased screening and online treatment for pain management, substance use, depression, anxiety and insomnia, Increased access to medication-assisted treatment (MAT), Peer support and recovery and resiliency services focusing on members development and achievement of health and wellness goals, and connection to community resources, Communication campaigns and resources, providing guidance for members and providers in a variety of convenient formats, Internal policies and procedures to reinforce coordination throughout the care management process, Mutual cooperation and coordination agreements to share clinically relevant information. Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. Healthcare providers may submit their requests for prior authorization of healthcare services to Magellan using the Texas Standard Prior Authorization Request Form for Health Care Services.. stream 2 0 obj Fax: 361-852-0624 For prior authorization and referrals managed by Magellan: Magellan Behavioral Health Providers of Texas, Inc. 1-800-729-2422: Behavioral health services - claims status inquiries. Behavioral Health Services are provided byMagellan Health Services. HealthChoiceswill notmake payments if the full obligations of the primary insurer(s) are not met. Read about our progress in the 2021 GuideWell Social Impact Report. endobj Member Questions Blue Cross Blue Shield members, please contact your BCBS company if you have specific questions about your plan, coverage and more. PDF Magellan Complete Care Provider Quick Guide Payers with unique claim filing rules - SimplePractice Support Blue Cross Blue Shield of Illinois is the location of the claims processing center and customer service center. <> *interactive voice response (IVR) system to access, you must have document control number (claim number), Blue Cross and Blue Shield of Texas Medicaid. External link You are leaving this website/app (site). (See item #2 below to learn how to contact your BCBS company to address any errors.) Check member eligibility, submit and check claims and find important information and more on our provider portal. Availity provides administrative services to BCBSTX. One option is Adobe Reader which has a built-in reader. The ERA or ANSI 835 transaction is a HIPAA-compliant method of receiving claim payment and remittance details. Magellan Behavior Health Services coordinates all behavioral health (mental health and chemical dependency) services for Medicaid (STAR), CHIP, and STAR Kids members. endstream endobj 137 0 obj <. Magellan continuously looks at our processes and procedures to improve service and increase efficiencies. All claims for covered services provided to HealthChoices Members must be submitted to and received by Magellan as follows: Within sixty (60) days from date of service for most levels of care except as provided below; Within sixty (60) days from date of discharge for 24/hr level of care; Within sixty (60) days of the last day of the month or the discharge date, whichever is earlier when billing monthly for longer treatment episodes of care at a 24/hr level facility; Within sixty (60) days of the claim settlement for third party claims. Dental Blue Book eManual; Dental Blue News; Dental Enrollment and Credentialing; hbbd```b``A$ Magellans Primary Care Physician (PCP) Toolkit. 1-800-451-0287* (Blue Choice PPO), 1-877-299-2377* (Blue Essentials and Blue Advantage HMO), 1-877-774-8592 (Blue Cross Medicare Advantage PPO & HMO), *interactive voice response (IVR) system - to access, you must have full member's information (for example, member's ID, patient's date of birth, etc.). Contact Availity or other electronic connectivity vendor or call Magellan Behavioral Health 1-800-729-2422, Claim filing address for Commercial products, Availity Essentials 2 Magellan Pennsylvania provider data, July 2017-June 2018 Click the link below to find the provider portal for your needs. Pharmacy claim submission and Pro- DUR questions ; 24 hours / 7 days a week; Magellan Rx Management Pharmacy Call Center: 1-800-424-5725. The Subscriber Claim Summary includes the name of the health care provider who sent us the claim, the date of service, the type of service (lab, surgery, medical care, etc.) This new site may be offered by a vendor or an independent third party. The easiest way to determine your current rates is to review the current rate sheet for your Magellan or affiliate company agreement. The Texas Department of Insurance developed the form to be used to request prior authorization for services for commercial insured members, Medicaid, Medicaid Managed Care, the Childrens Health Insurance Program (CHIP), plans covering employees of the state of Texas, school districts, and the University of Texas and Texas A&M systems. Corporate Address. Contact Information. Paper Claims must be submitted to the below addresses (claims are not accepted at the Care Management Center in Newtown): MBH-Bucks, PO Box 1715, Maryland Heights, MO 63043, MBH-Cambria, PO Box 2157, Maryland Heights, MO 63043, MBH-Lehigh, PO Box 2127, Maryland Heights, MO 63043, MBH-Montgomery, PO Box 2277, Maryland Heights, MO 63043, MBH-Northampton, PO Box 2065, Maryland Heights, MO 63043. The Blue Cross Blue Shield Association is an . Box 2048 Southeastern, PA 19399 Online: at www.bcbsglobalcore.com Users will obtain immediate feedback regarding the results of the test to ensure compliance with HIPAA rules and codes. HealthTrio Connect : To view this file, you may need to install a PDF reader program. Interested in exploring opportunities? Box 805107 Chicago, IL 60680-4112. Fax to: 1-888-579-7935 PO Box 660241 In accordance with applicable law, Magellan will pay clean claims within 45 days of the date of receipt. As a Magellan network provider, what is my timely filing limit?A. Or call your doctor or therapist for help. Utilization Management (Prior Authorizations), STAR Kids Referral and Authorization Process, Value-Added Services for STAR, CHIP and STAR Kids, Quality Improvements (QI) Toolkits and Tip Sheets, Home Delivery Pharmacy (Mail-Order Pharmacy), Medicaid (STAR) and CHIP Prior Authorization Forms, National Uniform Claim Committee (NUCC) 1500 Health Insurance Claim Form Reference Instruction Manual, Independent Review Organization (IRO) and EMR Provider Training, Interpreting the PLB Segment on the 835 ERA Guide. Our innovative approach includes: These programs not only address the symptoms of addiction; they also address the causes. 4 0 obj Secure Provider Web Portal (Electronic Verification System - EVS) Online Provider Enrollment (OPE) Online Prior Authorization (PA) system Online Claims Submission Online Provider Claim Appeals Audio Response System (ARS) (800-942-6511) Real time CAQH/CORE EDI eligibility and claim verification Provider PASRR Nevada Medicaid COVID-19 Eligibility and benefits contact Availity or other electronic connectivity vendor or call 1-800-442-4607*, Behavioral health services mental health and chemical dependency prior authorization and referrals (includes inpatient, residential treatment center (RTC) programs, partial hospitalization and outpatient behavioral health services) call 1-800-528-7264, Behavioral health services claims status inquiries contact Availity or other electronic connectivity vendor or call 1-800-442-4607*, Behavioral health services claim adjustments call 1-800-442-4607, Eligibility and benefits contact Availity or other electronic connectivity vendor or call 1-877-299-2377*, Claim status inquiries contact Availity or other electronic connectivity vendor, Medical Management Correspondence for the Health Insurance Marketplace for Blue Advantage HMO Members, Blue Cross Blue Shield of Texas Magellan steps in for our members to help prevent and address the risks of one affecting the other. Attention: Claim Department . BlueCard is our out-of-area program that allows members from other Blue Cross and Blue Shield Plans to receive health care benefits when travelling or residing in another Blue Plan's service area. If this is an emergency situation, you should do one of the following: Are you a provider looking for information on Magellan plans, joining our network, or performing secure transactions related to your practice or Magellan members? If you need to mail claims: Horizon BCBSNJ. With the backing of fully integrated health plans, and a wealth of experience collaboratively managing and coordinating care with physical health plan partners, we have the resources and expertise to achieve improved outcomes through: The linkages between physical and behavioral health are real. Health Coaching and Interventions: 1-800-672-7897 (toll free) Blue Cross and Blue Shield of North Carolina P.O. PO Box 10191. Yes. Authorizations & Referrals submissions By enforcing the timely filing requirement in the provider contract, we are able to focus our resources on what our providers have asked us to do - promptly pay claims. Instructions for submitting requests for predetermination Go directly to an emergency room. endobj (page_last_updated 03/2022) Authorization In an effort to make the authorization process easier for our EAP providers, New Directions EAP offers an authorization prompt on its telephone system (800-624-5544, prompt 3). From 2015 to 2017, our programs contributed to a 26% increase in members who were asked by their behavioral health providers to authorize communication with their PCP providers.3, Working with HealthConnections, the team helped get me to a place of not having fear, not having pain, exercising and doing yoga. 1001 E. Lookout Drive. Dental Expense Claim. Fax: 361-852-0624 Box 2064 . 1-800-637-0171, press 3 or 1-713-663-1149 Click the link below to find the provider portal for your needs. For this reason, your resubmitted claim has been denied. Claims Address. Services that require pre-authorization Blue Shield 65 Plus (HMO): Blue Shield 65 Plus Medicare Provider Appeals Department P.O. endstream endobj startxref Fax: 1-713-663-1227 Blue Cross Blue Shield of Massachusetts 101 Huntington Avenue, Suite 1300 Boston, MA 02199 . Questions related to a specific claim should be directed to the toll-free number on the member's ID card or the Explanation of Benefits. Mailing Address, Customer Service and Claims Contact Information Line of Business Customer Service/ Telephone Number Address Blue Shield of CA (BSC)/ MHSA 1-877-263-9952 1-800-424-6064 1-800-424-5999, option 3 Claims Mailing Address Blue Shield of California Mental Health Service Administrator (MHSA) P O Box 710400 San Diego, CA 92171 TennCare is happy to provide you an email response to your inquiry. In addition, some sites may require you to agree to their terms of use and privacy policy. Government Programs Claims Electronic claim submission is preferred, as noted above. x]rFwVa1)dJr#Qk%QKQ[93 yvk#Y _wOOOaxzXn&Wrru;8}N7o|Q2l1}e/_{12|qE2QPQ&/=d_W?F|)eAW+@y^n|"Gc9zOh 1-361-878-1623 114 Mesa Park Dr. Suite #300 <> . (Note:For behavioral health professional providers, refer to the Network Management Office Locations listed above). You should also check with your billing service, clearinghouse or software vendor to confirm ERA-compatibility and availability of auto-posting software. To verify eligibility or obtain authorization, you may contact Magellan at 1-800-424-4399. . If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. You are leaving this website/app (site). Blue Cross and Blue Shield of . Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. This is the customer service number for questions about your health insurance coverage, benefits or treatment. x}[s6{&.JIOwZd o/v//lwzv}|y_&TBn}?l.}oQdMy{~HbSMP7 s~o[}tUG0/Nyo{,J:T$aI|H@O_jVLyjV@>G77 Aug@GQO_>d+l6T5>A.1z{;|})eE&)35~5om[|{w-re^P=Jw"4Y]GW>+>4 *lBC3zcmW~\U0e.t^j2PtTU/%xz.w`]7OBu'!EW>K(>QEJ@&lh5. stream Will the timely filing standards be applied to claims I submitted prior to being a Magellan provider?A. This means that, subject to applicable state or federal laws, claims must be submitted toMagellan within 60 days of the date of service or inpatientdischarge. Submit completed forms to: Please select the appropriate version of the form below based on the members you serve. For the most recent information available in Pennsylvania including vaccine details, go to the, Claims/ Check Eligibility/ View Authorizations, You are on primary menu. Corpus Christi, TX 78411-4375 Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. Richardson, TX 75082-4144 Services include outpatient therapy, psychological testing, inpatient care, partial hospitalization, residential treatment, and intensive outpatient programs. Human Resources . Our innovative care coordination, case and utilization management programs, and vast network of behavioral health and specialty providers facilitate improved access to cost-effective and quality care while improving quality of life for the members we serve. Not a Magellan provider yet? Q. Arboretum Plaza II If you havent found what you need or have additional questions, press the button below to submit a general inquiry. Contact us By mail. Federal Employee Program claims Blue Cross Blue Shield of Michigan P.O. It is important for you to stay current with your specific state and/or plan/program requirements. A. Contact Magellan Health Services or call 1-800-788-4005, For prior authorization, benefits, eligibility, or claims status or questions contact Magellan at 1-800-327-7390. 4444 Corona, Suite 148 Become an Anthem provider and join the nation's second- largest health plan-owned behavioral health company, serving more than 13 . Contact Magellan Health Services or call 1-800-788-4005 For prior authorization, benefits, eligibility, or claims status or questions contact Magellan at 1-800-327-7390 Effective 6/27/2022, a Behavioral Health Service Coordination can help members manage complex conditions related to mental health and substance use. . Please emailwomenshealth@hhsc.state.tx.uswith any questions. For eligibility, prior authorization or claims inquiries, call 877-299-1008. Get answers to your questions by finding the email address or phone number you need. Join our extensive provider network today! The site may also contain non-Medicare related information. It is important that you review all EOPs promptly. Key Contact Information Blue Cross and Blue Shield of Texas, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). Registertoday with no set-up fees, monthly fees or per-claim fees charged to providers by visiting theAvaility websiteand selecting"Register". Paper Pharmacy Claims: Send to: Attention Paper Claims Processing. BCBSTX Behavioral Health Unit PO Box 660241 Dallas, TX 75266-0241 Fax 877-361-7646 Claims submission address: Blue Cross and Blue Shield of Texas P O Box 660044 Dallas, TX 75266-0044 For prior authorization and referrals managed by Magellan: Magellan Behavioral Health Providers of Texas, Inc. 800-729-2422 Note: For the requests below, utilize the indicated links: All other inquiries submit an email by selecting the office closest to your location and provide the Tax Identification Number, NPI, and if applicable, Medicare Numbers for your provider when contacting Network Management. all_rights_reserved. Providers Are you a provider looking for information on Magellan plans, joining our network, or performing secure transactions related to your practice or Magellan members? Email to submit provider inquiries and questions, Blue Cross and Blue Shield of Texas Clean claims are defined as claims that can be processed without obtaining any additional information from the provider or from a third party. Refer to BCBSTX Medicaid website and Contact Us. There, claims submission information is broken out by prefix/product name. We're here to help answer your questions. Do the timely filing limits apply to this claim?A. In Pennsylvania, Magellan works with county partners in Bucks, Cambria, Lehigh, Montgomery and Northampton counties. Box 7355 . Magellan recommends Claims Courier for low volume claim submitters who dont want to use a clearinghouse. Preauthorization requirementsfor Blue Cross and Blue Shield of Texas commercial plans(PDF), Magellan'sannual preauthorization reportfor BCBSTX commercial plans (PDF), Provider bulletin regarding Texas HB 3041 (PDF). Select Blue Cross Blue Shield Global or GeoBlue if you have international coverage and need to find care outside the United States. Blue Shield Initial Appeal Resolution Office Attn: Hospital Exception and Transplant Team P.O. Box 660027 3 0 obj It is important to note that depression can occur during pregnancy as well as after the baby is born. Why was my claim denied? Its a simple six-step process which includes uploading and sending test files. Q. Fax: 1-713-663-1227 Box 7026 Wheeling, WV 26003 Wisconsin Anthem Blue Cross Blue Shield The EPSarrives fasterthan the PCS andis easier to archivefor future retrieval. The Magellan timely filing standards (or in accordance with your state law) will be applied to claims for services rendered after you joined the Magellan network. Claims must be submitted and received by us within 24 months after the service takes place to be eligible for benefits. Information for Brokers, employers, and providers, as well as links to consumer health and wellness sites. You will be assigned an IT analyst to guide you through the process and address any questions. Tricare Phone Number and Claim Address. BlueCard Blue Cross and Blue Shield of Texas Providers may continue to call Magellan with their prior authorization requests, as the form does not replace other existing methods of contacting Magellan to request a prior authorization. Participating physicians, professional providers, ancillary and facility providers may not seek payment from the member for claims submitted after the 95-day filing deadline. endobj If you are able to create an 837 file in a HIPAA compliant format, we. Magellans PCP toolkit represents Magellans commitment to promote integration of medical and behavioral health services toward the goal of better overall outcomes for patients. Eligibility and benefits Premera Blue Cross (WA/AK) P. O. Behavioral Health Program Blue Cross and Blue Shield of Illinois (BCBSIL) manages behavioral health services for all commercial, non-HMO members who have behavioral health benefits through our group or retail products. General Member Service Correspondence. . Blue Cross Blue Shield of Arizona 2444 W Las Palmaritas Dr. Phoenix, AZ 85021 . 75890 or the EDI Support Mail Box:EDISupport@magellanhealth.com. Provider Services 1-800-521-6007 Representatives are available 24 hours a day, 7 days a week.. By email. Magellan Behavioral Health Providers! Medicaid Network Management Email to submit provider inquiries and questions. Once you get to your company's site, click on "Find Care" in the top menu to get to the provider search function. Upon receipt of your message, New Directions will fax or mail you the . Most PDF readers are a free download. You are on primary menu. Mail Claims or Claims Correspondence to: Blue Cross Blue Shield of Arizona P.O. Copyright 2022Health Care Service Corporation. 1-361-878-1623 Email Us. These members enjoy the same level of coverage as other Medicare Advantage members with no network restrictions. When you enroll for the ERA, you are automatically enrolled for the EPS, which is an electronic version of the paper PCS. ~_IV21b~Lj The 60-day inpatient readmission rate in Pennsylvania was nearly cut in half, from 21% to 11%, for members utilizing MAT at discharge versus those who were not.2. PDF File is in portable document format (PDF). Appeals address: Blue Cross and Blue Shield of Texas Attn: Complaints and Appeals Department PO Box 660717 Dallas, TX 75266-0717 Fax 1-855-235-1055 Email GPDTXMedicaidAG@bcbsnm.com Availity - Submit Claims Appeal Form Online Log into the Availity Provider Portal, select Payer Spaces from the top navigation menu and select BCBSTX. If your ID card is not available, you may use one of the Customer Service telephone numbers below. Complete the appropriate claim form - CMS-1500 forms are required for outpatient services and UB-04 forms are required for inpatient services. Make sure to send your claim form to the appropriate claims payer and specific address. The Texas Department of Insurance developed the form to be used to request prior authorization for services for commercial insured members, Medicaid, Medicaid Managed Care, the Children's Health Insurance Program (CHIP), plans covering employees of the state of Texas, school districts, and the University of Texas and Texas A&M systems. You can download the toolkithere. 1-713-663-1149 Fax: 972-766-2231 Q. I have a specific question about a claim. PO Box 660044. AIM Specialty Health (AIM) is an operating subsidiary of Anthem and an independent third party vendor that is solely responsible for its products and services. Pro- DUR questions ; 24 hours a day, 7 days a week ; Magellan Rx Management Pharmacy Center... 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Government programs claims electronic claim submission and claim number if applicable 65 Plus ( HMO ): Shield. A Magellan network provider, what is my timely filing limit? a leaving a voicemail... Management email to submit provider inquiries and questions this website/app ( site ) current rates to! S ) are not met at 1-800-424-4399. @ magellanhealth.com about your health insurance,. Are implemented across product lines but may differ by product or the Explanation of.! Your current rates is to review the current rate sheet for your needs 24 months after baby! Their terms of use and privacy policy obligations of the paper PCS sites may require you agree. Benefits or treatment Phoenix, AZ 85062-2924., TX 78411-4375 other Adobe accessibility tools and can. 1-713-663-1227 Blue Cross Blue Shield of Arizona 2444 W Las Palmaritas Dr. Phoenix, AZ.. Az 85062-2924. coverage and need to mail claims or claims Correspondence to: Attention paper claims Processing member ID... Improve service and increase efficiencies automatically enrolled for the EPS, which is an electronic version of the primary (... Innovative approach includes: These programs not only address the causes takes place to eligible! Are implemented across product lines but may differ by product apply to this claim? a any errors. claim. Accessibility tools and information can be downloaded at https: //access.adobe.com and claim number if.... Press 3 or 1-713-663-1149 Click the link below to learn how to contact BCBS... Plus ( HMO ): Blue Cross Blue Shield Association select claims service 1!
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