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. Visit our job search tool to find and apply to a position. (Note:For behavioral health professional providers, refer to the Network Management Office Locations listed above). hbbd```b``A$ Many times, primary care physicians are the first place a member goes when they have a problem. . 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). Participating physicians, professional providers, ancillary and facility providers may not seek payment from the member for claims submitted after the 95-day filing deadline. 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. Magellan Behavior Health Services coordinates all behavioral health (mental health and chemical dependency) services for Medicaid (STAR), CHIP, and STAR Kids members. *interactive voice response (IVR) system to access, you must have document control number (claim number), Blue Cross and Blue Shield of Texas Medicaid. 2022 Magellan Health, Inc. All Rights Reserved. General Information: 1-972-766-6900. We provide free eligibility and benefits verification as part of our billing . The site may also contain non-Medicare related information. As a Magellan provider, you are required to hold HealthChoices members harmless and cannot bill them for the difference between your contracted rate with Magellan and your standard rate. Dallas, TX 75266-0241 % Join Blue Cross and Blue Shield companies and leading voices from NAMI, Business Group on Health and Morgan, Lewis & Bockius LLP as they come together to discuss strategies for addressing pandemic-amplified behavioral health challengesparticularly as vaccines are rolling out and more focus on hybrid work models are set to spur workplace changes that can impact employee behavioral health. Blue Medicare HMO Blue Medicare PPO Contact: 1-888-296-9790 or. Bundling Rationale (Claims filed before Aug. 25, 2017) BlueCross BlueShield of Tennessee uses a clinical editing database. BCBS Prefix List AAA to AZZ. Human Resources . 195 0 obj <>stream 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. Fax: 1-713-663-1227 1999-2022 commercial_footer_copyright_magellan_link. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. For the latest information on flexibilities and extensions due to COVID-19, refer to theTexas Medicaid & Healthcare PartnershipandTexas Health and Human Services Commissionwebsites. The following items when submitted with your appeal may be considered evidence that your claim was submitted in a timely manner: Q. This new site may be offered by a vendor or an independent third party. To submit claims on Magellans website: Providers can submit claims using the Claims Courier application by signing in to the. Typically, a fee is attached by the clearinghouse vendor. Make sure to send your claim form to the appropriate claims payer and specific address. Outside the United States. BlueCross BlueShield of Tennessee is a Qualified Health Plan . When your BCBS ID card arrives in the mail, take a moment to look for these five things: 1. Instructions for submitting requests for predetermination Together, we're committed to making a meaningful difference in the health of all Floridians. What should I do? Services include outpatient therapy, psychological testing, inpatient care, partial hospitalization, residential treatment, and intensive outpatient programs. Log into the Availity Provider Portal, select Payer Spaces from the top navigation menu and select BCBSTX. The process typically takes about 3 to 4 weeks to complete the process, so allow ample time to complete your independent testing. Fax: 972-766-2231 Select Blue Cross Blue Shield Global or GeoBlue if you have international coverage and need to find care outside the United States. 4 0 obj endobj Behavioral health benefits are integrated into Anthem medical plans for a full spectrum of coordinated care for our members. Box 2924 Phoenix, AZ 85062-2924. . 1-972-766-8900 This claim is a resubmit; why was it denied for timely filing?A. A Claims Courier Demo can be accessed at: Claims Courier is a free web-based data entry application. Fax: 512-349-4853 Magellan is committed to the fight against the opioid epidemic and other substance use disorders (SUDs) affecting far too many of our family members and friends. Most people don't view their physical and mental health as separate, and neither do we. In addition, some sites may require you to agree to their terms of use and privacy policy. For eligibility, prior authorization or claims inquiries, call 877-299-1008. Use the link below to find your local BCBS company's website. 4 0 obj Credentialing Status. EDI Support: Contact Magellans EDI Hotline for support and/or assistance:1-800-450-7281ext. 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). Box 629011 El Dorado Hills, CA 95762-9011. Services billed beyond 95 days from the date of service are not eligible for reimbursement. The State Health Benefits Program (SHBP) and the School Employees' Health Benefits Program (SEHBP) Program: 1-800-991-5579. Information for Brokers, employers, and providers, as well as links to consumer health and wellness sites. Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. All Rights Reserved. 114 Mesa Park Dr. Suite #300 BlueCross BlueShield of Tennessee payer ID number: 00390. 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. 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. Q. I have never had a claim denied for timely filing reasons before; why is it being denied now?A. 800-637-0171, press 3 Claims Address: P.O. Mailing address: 5660 University Parkway. Note: Predetermination requests for members with Blue Cross and Blue Shield benefits in another state should be sent to the Plan indicated on the members ID card. Therefore it does not support revenue codes (codes submitted on 837I files or a UB-04). One option is Adobe Reader which has a built-in reader. Its a simple six-step process which includes uploading and sending test files. Place of Service 23. Copyright 2022Health Care Service Corporation. EFT is a direct deposit claim payment from BCBSTX to your designated bank account. Because claims mailing addresses are different for different Blue Plan members, using the Claims Routing Tool is the most accurate way to determine a claims mailing address. Magellan did not receive your resubmitted claim within our timely filing limits (or within the timely filing limits of your state) after the initial date of denial. Houston, TX 77027-3279 The form cannot be used for any other purpose except to request prior authorization of a healthcare service. 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. Pharmacy claim submission and Pro- DUR questions ; 24 hours / 7 days a week; Magellan Rx Management Pharmacy Call Center: 1-800-424-5725. hb```@(]K@1% V!iD3 7+S#UBCm0#LiF j9vvfL4 q* . Key Contact Information <> endobj Box 2064 . Please select the appropriate version of the form below based on the members you serve. However, before sending an email to TennCare you may be able to find a quick answer online by clicking on one of these questions. Box 710400 . 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. Place of Service 22. Visit our Help Center . Richardson, TX 75082-4144 Braven Health: 1-888-444-0501. We're here to help answer your questions. Behavioral Health Services: 1-800-266-6167. Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. Corpus Christi, TX 78411-4375 <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 24 0 R 25 0 R 26 0 R 27 0 R 30 0 R] /MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 9442 Capital of Texas Hwy N, Suite 500 Government Programs Claims Electronic claim submission is preferred, as noted above. Maryland Heights, MO 63043 . Dental Expense Claim. Fax: 713-663-1227 Email to submit provider inquiries and questions, Ambulatory Surgery Centers (ASC) Independent, Non-Hospital owned, Fax: 1-713-663-1227 Box 272640 Chico, CA 95927-2640 You should also check with your billing service, clearinghouse or software vendor to confirm ERA-compatibility and availability of auto-posting software. Are you a member looking to access behavioral health or EAP services sponsored through your employer? Q. Download information about our behavioral health solutions and public behavioral health overview. Click the link below to find the provider portal for your needs. Box 211184 Eagan, MN 55121 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. Box 7026 Wheeling, WV 26003 Wisconsin Anthem Blue Cross Blue Shield 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. Will the timely filing standards be applied to claims I submitted prior to being a Magellan provider?A. Yes. Magellan was the first MBHO to have a program included in this publication. *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*. In addition, some sites may require you to agree to their terms of use and privacy policy. Box 805107 Chicago, IL 60680-4112. HealthChoiceswill notmake payments if the full obligations of the primary insurer(s) are not met. Copyright 2022Health Care Service Corporation. Our innovative approach includes: These programs not only address the symptoms of addiction; they also address the causes. Vision/Hearing Claim. Contact Magellan Healthcare. 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). Magellan recommends Claims Courier for low volume claim submitters who dont want to use a clearinghouse. Member Questions Blue Cross Blue Shield members, please contact your BCBS company if you have specific questions about your plan, coverage and more. Click to skip to content. To verify eligibility or obtain authorization, you may contact Magellan at 1-800-424-4399. . Blue Shield Final Appeal Resolution Office P.O. Claim forms must be submitted to: Blue Cross and Blue Shield of Alabama. Fax: 915-496-6614 Click the link below to find the provider portal for your needs. Please emailwomenshealth@hhsc.state.tx.uswith any questions. Through this option, providers submit an 837 file to a third party middle-man who in turn submits the files to Magellan. Fax: 1-800-424-5881. External link You are leaving this website/app (site). % 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. 1-915-496-6600, press 2