Find your provider portal stream The site may also contain non-Medicare related information. If you need to mail claims: Horizon BCBSNJ. For status call: BlueCross BlueShield of Tennessee is a Qualified Health Plan . 75890 or the EDI Support Mail Box:EDISupport@magellanhealth.com. The site may also contain non-Medicare related information. The toolkit includes coverage and reimbursement options for postpartum depression through Medicaid, CHIP, the Healthy Texas Women Program, the Family Planning Program and other referral options. 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. From theResourcessection, selectState & Plan Information,then under State-Specific, click theTexaslinkto access to access the following forms: Texas State Bill 1742: Preauthorization requirements, Standard Prior Authorization Request Form for Health Care Services, Texas Health and Human Services Commission, Preauthorization requirementsfor Blue Cross and Blue Shield of Texas commercial plans, Provider bulletin regarding Texas HB 3041, American Society of Addiction Medicine (ASAM), BlueCross BlueShield of Texas Medicaid STAR,CHIP and STAR Kids, Texas-specificABA Treatment Plan/Concurrent Review. Please send your claims for imaging procedures to the following address: BlueAdvantage Operations 1 Cameron Hill Suite 0002 Chattanooga TN 37402-0002 Please continue to use EDI claims submission. Vision/Hearing Claim. To obtain an aggregate number of grievances, appeals, and exceptions filed with BlueRx (PDP) contact Member Services at 1-800-327-3998 (BlueRx AL) or 1-888-311-7508 (BlueRx TN), 8 a.m. to 8 p.m., seven (7) days a week. APPEALS . It is important to note that depression can occur during pregnancy as well as after the baby is born. *interactive voice response (IVR) system to access, you must have document control number (claim number), Eligibility and benefits contact your electronic connectivity vendor, Availity or other electronic connectivity vendor or call 1-800-451-0287*. 10 things to check each time you submit a claim: Q. I believe I am being paid the incorrect rate. Please note: as these requirements can be subject to change, thegrid may not contain a complete list of exceptions. Blue Shield 65 Plus (HMO): Blue Shield 65 Plus Medicare Provider Appeals Department P.O. Download information about our behavioral health solutions and public behavioral health overview. Magellan employs many methods to identify members with complex needs to match them with the appropriate level of specialized case management services, including: Our team provides the compassionate extra support individuals need to overcome significant behavioral health and life challenges. Box 710400, San Diego CA 921710400 Phone Number: (877) 263-9952 Blue Shield of CA: Payer ID: BS001 Claims Address: P.O. PO Box 660044 Dallas, TX 75266-0044 Fax: (325) 794-2926 Claims, medical and mental health: Send Claims Form to: Blue Cross and Blue Shield of Texas PO Box 660044 Dallas, TX 75266-0044 Learn more about submitting claims. Most people don't view their physical and mental health as separate, and neither do we. If after reviewing your rates you still believe there is an error, please contact the toll-free number on the member's ID card or the Members Explanation of Benefits, or call your Magellan network representative. Box 629011 El Dorado Hills, CA 95762-9011. 1-361-878-1623 Appeals Provider Manual June 2021 15.5 15 Requesting an appeal For all Part C and Part D standard appeals, the Member or his or her authorized representative should mail the written appeal to: Keystone 65 HMO/Personal Choice 65 PPO Member Appeals Department Mail your payment to the address on your premium invoice or learn about other convenient ways to pay your bill. The form cannot be used for any other purpose except to request prior authorization of a healthcare service. Claims must be submitted and received by us within 24 months after the service takes place to be eligible for benefits. Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. Email to submit provider inquiries and questions, Austinand Central TX (Bastrop, Bell, Bosque, Burleson, Burnett, Caldwell, Falls, Fayette, Hays, Hill, Lee, Leon, Limestone, Madison, Milam, McLennan, Robertson, Travis, Williamson counties), Blue Cross and Blue Shield of Texas 114 Mesa Park Dr. Suite #300 Services that require pre-authorization Contact Magellan Healthcare. Self-enroll by creating a unique user ID and password. Please emailwomenshealth@hhsc.state.tx.uswith any questions. 3 0 obj FBC HOM 001 F 102022. Claim status inquiries contact Availity or other electronic connectivity. Fax 877-361-7646, Claims submission address: Box 272640 Chico, CA 95927-2640 Box 85042. Copy of EOP from the medical/health plan vendor substantiating their denial date. Dental Blue Book eManual; Dental Blue News; Dental Enrollment and Credentialing; In addition, some sites may require you to agree to their terms of use and privacy policy. BCBSTX Behavioral Health Unit DO NOT COMPLETE THIS FORM IF YOU ARE A MAGELLAN COMPLETE CARE MEMBER OR PROVIDER. Magellan was the first MBHO to have a program included in this publication. 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 Behavioral Health Services: 1-800-266-6167. Will the timely filing standards be applied to claims I submitted prior to being a Magellan provider?A. (See item #2 below to learn how to contact your BCBS company to address any errors.) Not a Magellan provider yet? Ask them where out of state claims should be filed. Therefore it does not support revenue codes (codes submitted on 837I files or a UB-04). We really moved forward together., -Magellan Behavioral Health of Pennsylvania (HealthConnections) member. Q. I have proof that I submitted the claim within the timely filing limits. (page_last_updated 03/2022) Fax: 972-766-2231 Clean claims are defined as claims that can be processed without obtaining any additional information from the provider or from a third party. <> Q. I have a specific question about a claim. 9442 Capital of Texas Hwy N, Suite 500 Contact Name Contact Address 1: Contact Address 2 Contact City: St Zip: . Box 805107, Chicago, IL 60680-4112. What is the appeals process? Winston-Salem, NC 27105. 1-915-496-6600, press 2 P.O. 3 0 obj Montgomery:(877) 769-9782 Northampton:(866) 238-2312 Provider Services Contact Information: Bucks/Montgomery: (877) 769-9779 Cambria:(800) 424-3711 Lehigh/Northampton:(866) 780-3368 Information For Members & Providers: TTY (All counties):PA Relay 7-1-1 Fraud & Abuse:(800) 755-0850 For Emergency Situations, Always Call 911 Place of Service 23. 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. A Claims Courier Demo can be accessed at: Claims Courier is a free web-based data entry application. Fax: 1-713-663-1227 San Diego, CA 92171 . TennCare is happy to provide you an email response to your inquiry. All Rights Reserved. What should I do? % Florida Blue is a part of the GuideWell family of companies. 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? General Member Service Correspondence. Fax: 361-852-0624 Claim Status; For Availity-related questions, please visit the Availity Essentials website or contact Availity Essentials Client Service at 1-800-282-4548, 8 a.m. to 8 p.m. <> The EPSarrives fasterthan the PCS andis easier to archivefor future retrieval. Although it is not preferred, providers may also submit paper claims via a CMS-1500 form (Non-Facility-Based Providers) or UB-04 form (Facility-Based Providers). Q. I recently joined the Magellan provider network. Fax: 361-852-0624 BCBS Provider Phone Number. stream There is a simple testing process to determine if Direct Submit is right for you. 800-637-0171, press 3 Our innovative approach includes: These programs not only address the symptoms of addiction; they also address the causes. Place of Service 22. Claim status inquiries (out-of-state subscribers) contact Availity or other electronic connectivity vendor. Explore more about our programs and services addressing behavioral health, including substance use disorder treatment, and integration with physical health. Key Contact Information PO Box 660241 Blue Cross and Blue Shield of Illinois 300 East Randolph Street Chicago, Illinois 60601-5099. In-network providers will be paid at their contracted rate. Box 272540, Chico CA 959272540 Phone Number: (800) 541-6652 Is Blue Shield MHSA the same as Magellan? . BCBS Prefix List - Alpha. Submit completed forms to: For Emergency Situations, Always Call 911. 195 0 obj <>stream Box 312599 Detroit, MI 48231-2599. Blue Cross Blue Shield of Massachusetts 101 Huntington Avenue, Suite 1300 Boston, MA 02199 . <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 19 0 R 25 0 R 26 0 R] /MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Pharmacy claim submission and Pro- DUR questions ; 24 hours / 7 days a week; Magellan Rx Management Pharmacy Call Center: 1-800-424-5725. The easiest way to determine your current rates is to review the current rate sheet for your Magellan or affiliate company agreement. We provide free eligibility and benefits verification as part of our billing . The Blue Cross Blue Shield Association is an association of 35 independent, locally operated Blue Cross and/or Blue Shield companies. Enforcing this clause also brings us in line with industry practices. Email to submit provider inquiries and questions, Blue Cross and Blue Shield of Texas Blue Shield Initial Appeal Resolution Office Attn: Hospital Exception and Transplant Team P.O. If you havent found what you need or have additional questions, press the button below to submit a general inquiry. 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 If you are a member with a question about your coverage, contact Customer Service at the number listed on your BCBSIL member ID card. Through increased access to evidence-based treatment options and effective preventive measures, we are making it easier for members to recover and stay out of hospitals. P O Box 660044 Blue Shield Final Appeal Resolution Office P.O. This new site may be offered by a vendor or an independent third party. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Eligibility and benefits No. PDF File is in portable document format (PDF). Richardson, TX 75082-4144 Claims for services provided to HealthChoices Members who have another primary insurance carrier must be submitted to the primary insurer first in order to obtain an EOB. Fax: 915-496-6614 2. Still looking for additional help? 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.). ET, Monday through Friday. 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. 1 Cameron Hill Circle . 2615 Calder St, Suite 700 The following address should be used for claims related to outer counties: Outer County Claims - Lehigh, Lancaster, Northampton, and Berks County Claims Receipt Center P.O. As a Magellan network provider, what is my timely filing limit?A. Availity EFT & ERA Enrollment User Guide. Claims submission address: Blue Cross and Blue Shield of Texas P O Box 660044 Dallas, TX 75266-0044. Dallas, TX 75266-0044 TTY: 735-2989. BCBSTX providers who receive paper checks and Provider Claim Summaries (PCSs) via the U.S. Mail may wish to consider the electronic alternatives listed below for greater efficiency, convenience and security of information. Again, this can be a huge time-suck, calling and being transferred over and over. MagellansMedical Providers Behavioral Health Toolkitgives medical practitioners the information and screening tools needed to assist in making behavioral health referrals. 1999-2022 commercial_footer_copyright_magellan_link. Email to submit provider inquiries, 1001 E. Lookout Drive Email to submit provider inquiries and questions, Blue Cross and Blue Shield of Texas and the amount . Use the link below to find your local BCBS company's website. 1 0 obj hb```@(]K@1% V!iD3 7+S#UBCm0#LiF j9vvfL4 q* 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. Q. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. When submitting claims electronically, the Magellan submitter ID is 01260. A. ~_IV21b~Lj Resubmitted claims should include the Date of Original Submission and Claim number if applicable. Richardson, Texas 75082. For exceptions to the standard timely filing requirements for specific states and/or plans/programs, refer to your contract withMagellan and/or its affiliates; see theMagellan state-, plan-and EAP-specific handbook supplements; refer to our timely filingexception grid; or consult state and federal laws. This claim is a resubmit; why was it denied for timely filing?A. If you are enrolled in a Lowe's medical plan with BCBS AL, you will contact Magellan Health for services (1-877-543-3875, press 2, then press 1). PO Box 10191. Magellan continuously looks at our processes and procedures to improve service and increase efficiencies. Federal Employee Program claims Blue Cross Blue Shield of Michigan P.O. Log into the Availity Provider Portal, select Payer Spaces from the top navigation menu and select BCBSTX. P.O. Become an Anthem provider and join the nation's second- largest health plan-owned behavioral health company, serving more than 13 . 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. Key Contact information PO Box 660241 Blue Cross Blue Shield of Texas N! Document format ( pdf ) tools and information can be a huge time-suck, calling and being transferred and! From the medical/health Plan vendor substantiating their denial date claims submission address: Blue Cross and/or Blue MHSA. 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