Identify the service provider including degree level, using appropriate modifiers, if necessary.

Include and verify the correct Taxpayer Identification Number (TIN) and National Provider Identifier (NPI) - Remember that services authorized under a group TIN must be submitted for payment under that group's TIN.

Bill only for services included in your provider contract.

Make sure diagnosis and procedure codes are correct and match the services rendered.

Make sure the billed service submitted for payment is covered by the authorization, if applicable.Make sure that service dates are within the authorized time period, if applicable.Be sure to include the specific member, or member's dependent identification number.Watch out for name variations or changes. Make sure the member's name appears on the claim form just as it appears on the insurance card.Magellan has separate post office boxes for the accounts for which we provide claims payment services. Make sure to send your claim form to the appropriate claims payer and specific address.Complete the appropriate claim form- CMS-1500 forms are required for outpatient services and UB-04 forms are required for inpatient services.There are several reasons claims may not be paid upon their first submission. As a first step, always review the Explanation of Payment (EOP) or Explanation of Benefits (EOB) and determine the reason why the claim was denied before resubmitting a new claim.ġ0 things to check each time you submit a claim: Copy of EOP from the medical/health plan vendor substantiating their denial date.Ī.Copy of 2nd level EDI 277 acceptance reports.Copy of the claim with Magellan's date stamp within the timely filing period.Certified or overnight mail receipts dated within the timely filing period.Copy of an EOP with a date within the timely filing period.The following items when submitted with your appeal may be considered evidence that your claim was submitted in a timely manner: 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). What is the appeals process? Where do I send the claim information?Ī. I have proof that I submitted the claim within the timely filing limits. You are responsible for verifying the member's coverage at the time of service. Do the timely filing limits apply to this claim?Ī. 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. Claims are paid based on your status on the date of service. Will the timely filing standards be applied to claims I submitted prior to being a Magellan provider?Ī. I recently joined the Magellan provider network. Does this timely filing limit apply to all claims for all members (e.g., COB, Medicare, etc.)?Ī.

For this reason, your resubmitted claim has been denied. 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. This claim is a resubmit why was it denied for timely filing?Ī. Enforcing this clause also brings us in line with industry practices. 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. Magellan continuously looks at our processes and procedures to improve service and increase efficiencies. I have never had a claim denied for timely filing reasons before why is it being denied now?Ī. It is important for you to stay current with your specific state and/or plan/program requirements. Please note: as these requirements can be subject to change, the grid may not contain a complete list of exceptions. If claims are submitted after the timely filing limit, they will be denied for payment, subject to applicable state and federal laws.įor exceptions to the standard timely filing requirements for specific states and/or plans/programs, refer to your contract with Magellan and/or its affiliates see the Magellan state-, plan- and EAP-specific handbook supplements refer to our timely filing exception grid or consult state and federal laws. This means that, subject to applicable state or federal laws, claims must be submitted to Magellan within 60 days of the date of service or inpatient discharge. Under Magellan's policies and procedures, the standard timely filing limit is 60 days. As a Magellan network provider, what is my timely filing limit?Ī.

Blue cross timely filing