NOTE: To gain access to the above Blue Cross and Blue Shield of Texas Medicaid Tools you must be registered with Availity. Download information about our behavioral health solutions and public behavioral health overview. Arboretum Plaza II 4 0 obj
If you are a member with a question about your coverage, contact Customer Service at the number listed on your BCBSIL member ID card. Box 9000 London, KY 40742 Phone: (866) 510-8778 Blue Shield Medicare Advantage Blue Shield Medicare Advantage Plan P.O. As a Magellan network provider, what is my timely filing limit?A. ET, Monday through Friday. You are responsible for verifying the member's coverage at the time of service. 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. Email to submit provider inquiries, Blue Cross and Blue Shield of Texas (BCBSTX). Information for Brokers, employers, and providers, as well as links to consumer health and wellness sites. Blue Cross and Blue Shield of Texas Box 30271 Salt Lake City, UT 84130-0271 *Washington Regence Group Administrators Attn: Claims P. O. Submit appeals within 120 calendar days from receipt of remittance advice (RA). Box 52890 Bellevue, WA 98015- 2890 West Virginia Highmark BCBS of WV P.O. Instructions for submitting requests for predetermination PO Box 660241 Call 1-800-528-7264 or the phone number listed on the back of the member's/subscriber's ID card. 800-676-BLUE (2583). Other Adobe accessibility tools and information can be downloaded at https://access.adobe.com. 1998-BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the Blue Cross Blue Shield Association. 1-361-878-1623 Click to skip to content, You are on secondary menu. Blue Cross and Blue Shield of Texas - Claims PO Box 660044 Dallas, TX 75266-0044 How to submit an international claim You can submit your completed international claim form and documentation using one of the following methods: By mail: Service Center P.O. Click the link below to find the provider portal for your needs. Box 32593 Detroit, MI 48232-0593. 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. Visit our job search tool to find and apply to a position. 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.. Box 2924 Phoenix, AZ 85062-2924. . Join our extensive provider network today! Email to submit provider inquiries and questions, Ambulatory Surgery Centers (ASC) Independent, Non-Hospital owned, Fax: 1-713-663-1227 Please provide the Tax Identification Number, NPI, and if applicable, Medicare Numbers for your provider when contacting Network Management. endstream
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Please note: as these requirements can be subject to change, thegrid may not contain a complete list of exceptions. If you have a question about . Provide LRS with the Blue Cross toll-free number (1-800-495-2583) to direct your call to the . Don't have your card? San Antonio, TX 78257-8222 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 The ERA can be automatically posted to your patient accounting system. 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. BCBS Customer Service Call the toll-free number on the back of your member ID card for BCBS customer service. Go directly to an emergency room. 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 Electronic claims filing system, Benefit disclosure information (form available online), Online: Use Availity Attachments application, Mail form to: 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. endobj
P.O. 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 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. Medicaid and CHIP Claim Editing Enhancements Coming Feb. 23, 2022, ICD -10 Z Codes for Social Determinants of Health, How to Submit a Complaint as a Medicaid Provider, Medicaid Provider Information on COVID-19 Coverage, Members can ask for an External Medical Review (EMR) and State fair Hearing from the state Medicaid program and get information about how the process works in our provider alert. Again, this can be a huge time-suck, calling and being transferred over and over. Providers can refer members by contacting 1-877-214-5630. Please select the appropriate version of the form below based on the members you serve. Box 710400, San Diego CA 921710400 Phone Number: (877) 263-9952 Blue Shield of CA: Payer ID: BS001 Claims Address: P.O. 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, Medical Providers Behavioral Health Toolkit, Magellan HealthCare Provider Focus News and Information, Applied Behavioral Analysis (ABA) Provider FAQ, Medicaid Provider Information on COVID-19 Coverage. 2615 Calder St, Suite 700 Credentialing Status. 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. Note: If you are a Blue Cross and Blue Shield of Alabama customer and need to reach us by phone, please use the telephone number(s) on the back of your ID card. Magellan Behavioral Health Providers! 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 When your BCBS ID card arrives in the mail, take a moment to look for these five things: 1. 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. <>
General Member Service Correspondence. When the confirmation message displays, select, To enroll online for EFT, you must be a registered Availity, Texas Medicaid claims are normally finalized weekly on Mondays. 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). Specializing in the most complex, costly areas of care, Magellan Healthcare partners with states to manage behavioral health programs. Within BCBSTX-branded Payer Spaces, select the Applications tab and click the BCBSTX Medicaid Provider Appeal Request Form. When submitting claims electronically, the Magellan submitter ID is 01260. We provide free eligibility and benefits verification as part of our billing . Most people don't view their physical and mental health as separate, and neither do we. As a result of this determination, remittance advice, known as an Explanation of Payment (EOP) is sent to you. endobj
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. Through this option, providers submit an 837 file to a third party middle-man who in turn submits the files to Magellan. See first question and answer above. El Paso, TX 79912 -6156 This is the customer service number for questions about your health insurance coverage, benefits or treatment. Box 629010 El Dorado Hills, CA 95762-9010. Magellan Healthcare is contracted to perform behavioral health managed care functions supporting members and participants for the following Blue Cross and Blue Shield of Texas HMO networks; Blue Advantage HMO SM, Blue Cross Medicare Advantage HMO SM, Blue Cross Medicare Advantage Dual Care (HMO SNP) SM and MyBlue Health SM. EFT is a direct deposit claim payment from BCBSTX to your designated bank account. This new site may be offered by a vendor or an independent third party. BlueCross BlueShield of Tennessee is a Qualified Health Plan . If you are able to create an 837 file in a HIPAA compliant format, we. 2 0 obj
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1-800-749-0966 Medicaid Phone Number. FBC HOM 001 F 102022. However, before sending an email to TennCare you may be able to find a quick answer online by clicking on one of these questions. Refer to BCBSTX Medicaid website and Contact Us. Click to skip to content, You are on secondary menu. Clean claims are defined as claims that can be processed without obtaining any additional information from the provider or from a third party. Visit our Help Center . 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. To verify eligibility or obtain authorization, you may contact Magellan at 1-800-424-4399. . A Claims Courier Demo can be accessed at: Claims Courier is a free web-based data entry application. 1-915-496-6600, press 2 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. Users will obtain immediate feedback regarding the results of the test to ensure compliance with HIPAA rules and codes. 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). Box 805107 Chicago, IL 60680-4112. 1-800-336-5696 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. 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 In Texas, Magellan uses the American Society of Addiction Medicine (ASAM) criteria as the basis for the utilization reviews of substance use disorder cases. You should also check with your billing service, clearinghouse or software vendor to confirm ERA-compatibility and availability of auto-posting software. We encourage you to submit claims electronically, via www.MagellanProvider.com or through a clearinghouse. This new site may be offered by a vendor or an independent third party. 1001 E Lookout Drive Upon receipt of your message, New Directions will fax or mail you the . Make sure to send your claim form to the appropriate claims payer and specific address. 3 0 obj
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As a Behavioral Health-Managed Care Organization (BH-MCO), Magellan manages members' benefits in coordination with you - our network providers. Magellan Center for Recovery and Resiliency, Magellan Youth Leaders Inspiring Future Empowerment (MY LIFE), Digital emotional wellbeing for every day, Magellan Genetic Testing Information Request, Request More Information about Magellan Healthcares DecisionPoint, Nurse navigation and Wellness Recovery Teams focused on improved physical, and behavioral health, as well as the social determinants of health, You are on primary menu. Blue Cross and Blue Shield of Texas Pharmacy Claim. These members enjoy the same level of coverage as other Medicare Advantage members with no network restrictions. Dallas, TX 75266-0027, Prior authorization of Medical Services for the Health Insurance Marketplace for Blue Advantage HMO Members, Eligibility and benefits contact Availity or other electronic connectivity vendor or call 1-800-451-0287*, Behavioral health services mental health and chemical dependency, For prior authorization and referrals managed by BCBSTX: (includes inpatient, residential treatment center (RTC) programs, partial hospitalization and outpatient behavioral health services). Interested in exploring opportunities? Fax: 361-852-0624 1-512-349-4847 Email to submit provider inquiries and questions, North Texas Dallas, Fort Worth, East Texas (ExcludesBastrop, Bell, Bosque, Burleson, Burnett, Caldwell, Falls, Fayette, Hays, Hill, Lee, Leon, Limestone, Madison, Milam, McLennan, Robertson, Travis, Wichita and Williamson counties), Blue Cross and Blue Shield of Texas Email: RxNetworksDept@magellanhealth.com. Claims Address. BlueCross BlueShield of Tennessee payer ID number: 00390. Horizon Behavioral Health. 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. 3 0 obj
In accordance with applicable law, Magellan will pay clean claims within 45 days of the date of receipt. You can download the toolkithere. Click to skip to content. Blue Cross Complete claims P.O. Through the Homeless Outreach Positive Engagement intensive case management program, Magellan has helped 81% of members obtain housing and 61% reduce their number of hospital days.1. Claims must be submitted and received by us within 24 months after the service takes place to be eligible for benefits. No. The State Health Benefits Program (SHBP) and the School Employees' Health Benefits Program (SEHBP) Program: 1-800-991-5579. ~_IV21b~Lj PDF File is in portable document format (PDF). 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. Eligibility and benefits Still looking for additional help? Magellan's Caroline Carney, MD, MSc, FAPM, CPHQ, recently co-chaired the National Quality Forum Committee with funding from the Centers for Medicare & Medicaid Services (CMS) to develop guidance for healthcare stakeholders to successfully implement the Opioids and Behavioral Health Measurement Framework and ultimately help combat the opioid crisis. In addition, some sites may require you to agree to their terms of use and privacy policy. Most PDF readers are a free download. What should I do? For Emergency Situations, Always Call 911. %PDF-1.7
Will the timely filing standards be applied to claims I submitted prior to being a Magellan provider?A. Keystone First 200 Stevens Drive Philadelphia, PA 19113. Blue Shield 65 Plus (HMO): Blue Shield 65 Plus Medicare Provider Appeals Department P.O. 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. By telephone. Availity provides administrative services to BCBSTX. You are on primary menu. APPEALS . Box 91059 Seattle, WA 98111-9159 *Washington Regence Blue Shield P. O. 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). The Blue Cross Blue Shield Association is an . If you havent found what you need or have additional questions, press the button below to submit a general inquiry. P. O. For urgent requests only: Vision/Hearing Claim. Please emailwomenshealth@hhsc.state.tx.uswith any questions. Ask them where out of state claims should be filed. ), For services managed by Magellan: 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. This new site may be offered by a vendor or an independent third party. Do the timely filing limits apply to this claim?A. Learn how to enroll online for EFT and ERA transactions by referring to theAvaility EFT & ERA Enrollment User Guide. The form cannot be used for any other purpose except to request prior authorization of a healthcare service. Fax: 713-663-1227 and the amount . 10 things to check each time you submit a claim: Q. I believe I am being paid the incorrect rate. . 1-361-878-1623 Government Programs Claims Electronic claim submission is preferred, as noted above. 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. 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. Blue Cross and Blue Shield of Texas. Use the link below to find your local BCBS company's website. BCBSTX makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer. Blue Shield Initial Appeal Resolution Office Attn: Hospital Exception and Transplant Team P.O. 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). Richardson, TX 75082-4144 1 Cameron Hill Circle . P.O. Submit completed forms to: Key Contact Information BCBS Prefix List - Alpha. 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. Attn: Predetermination Dept. This date is based on the date of the other carriers decision. Email to submit provider inquiries and questions, Golden Triangle (Beaumont, Orange, Port Arthur), Blue Cross and Blue Shield of Texas . 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. A. 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. UB-04 claims Blue Cross Blue Shield of Michigan P.O. This claim is a resubmit; why was it denied for timely filing?A. Mailing address 1901 Market Street Philadelphia, PA 19103-1480 Email Complete the Provider Communications Email Sign-up Form to receive email updates with the latest information, including Partners in Health UpdateSM. Travel Benefit Claim. Braven Health: 1-888-444-0501. 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. Box 85042. Austin, TX 78759-7228 endobj
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Availity EFT & ERA Enrollment User Guide. Fax: 1-713-663-1227 Q. I did not submit a claim due to a change in coverage for the member in question. 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. Paper Claim Filing; Dental Providers. Medical Care Management EAP providers can request an EAP authorization by leaving a brief voicemail message. From February 15 to September 30, on weekends and holidays, you may be required to leave a message. Fax: 1-800-424-5881. Box 2048 Southeastern, PA 19399 Online: at www.bcbsglobalcore.com Please be aware that inquiries and email boxes are not monitored 24/7. Double-Check Details Check your new card to ensure details like the spelling of your name and the type of plan you selected are correct. 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. Q. . Richmond, VA 23242 Upon receipt of the completed form(s), Magellan will begin the prior authorization process. Box 7355 . MagellansMedical Providers Behavioral Health Toolkitgives medical practitioners the information and screening tools needed to assist in making behavioral health referrals. 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. Find My BCBS Company Magellans Primary Care Physician (PCP) Toolkit. 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. Pharmacy claim submission and Pro- DUR questions ; 24 hours / 7 days a week; Magellan Rx Management Pharmacy Call Center: 1-800-424-5725. Richardson, TX 75082-4144 Magellan has had sites accredited by URAC since 1992. Out-of-network providers will be paid the Medicare-allowed amount less any member cost-sharing. P O Box 660044 Skip to article content, Electronic Data Interface (EDI) via Direct Submit, Claims Courier-Magellans Web-based Claims submission tool, Paper Claims: CMS-1500 (Non-Facility-Based Providers) or UB-04 (Facility-Based Providers). * (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. (page_last_updated 03/2022) Blue Cross Blue Shield of Arizona 2444 W Las Palmaritas Dr. Phoenix, AZ 85021 . Enforcing this clause also brings us in line with industry practices. . Provider Services 1-800-521-6007 Representatives are available 24 hours a day, 7 days a week.. By email. Phone: 1-713-354-7033 Postpartum depression is a common, potentially serious and sometimes life-threatening condition. A. Contact Availity or other electronic connectivity vendor or call 1-800-451-0287*, *interactive voice response (IVR) system to access, you must have full member's information (for example, member's ID, patients date of birth, etc. Members enjoy the same level of coverage as other Medicare Advantage Plan P.O of! Amount less any member cost-sharing learn how to enroll online for EFT and ERA transactions by to! Office Attn: Hospital Exception bcbs magellan claims address Transplant Team P.O may contact Magellan 1-800-424-4399.. 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