2013 Practitioner and Provider Manual - Presbyterian Healthcare ...

Behavioral HealthClaims Submission ProceduresPresbyterian maintains the primary responsibilityfor all behavior health care claims adjudication andpayments for Medicare and Commercial members.Claims from Centennial Care behavioral healthproviders relating to mental health or substanceabuse services may be submitted to Magellandirectly if that is more convenient for the provider,but be assured that all behavioral health claims –even as part of a mixed service – may always besubmitted directly to Presbyterian and we willreroute the behavioral claims to Magellan foradjudication and payment.Submitting Electronic Transactions/ClaimsPresbyterian and Magellan encourage providers totake advantage of our electronic claimstransmission (ECT) process. ECT has become thepreferred method of claims submission for themajority of our network.Benefits of Filing ElectronicallyPresbyterian generally processes electronicallysubmitted claims in an average of seven days,whereas hard copy claims are generally processedin an average of 14 days. Electronic submissionsaves postage and paper and also gives theproviderQuicker confirmation of claims receipt andintegrity of the dataA higher percentage of claims accuracy,resulting in faster paymentClaims data already formatted into the HealthInsurance Portability and Accountability Act(HIPAA)-required ANSI-X12 837 claims formatClaims CourierAccessible through the Magellan provider websiteat www.magellanprovider.com, Claims Courier is adata entry application for Centennial Care providerssubmitting professional claims on a claim-at-a-timebasis. Providers can gain access to Claims Courierby signing onto the Magellan website with their username and password and following the instructionsunder “Submit a Claim Online.” Claims Courierstreamlines the claims process by eliminating theclaims middleman, and there is no charge to theprovider for using the service. The provider simplyenters the claims information data into the onlineClaims Courier application. Note that Magellanmust be the designated payer in order to processthe submitted claims.On the main Claims Courier (Submit a Claim) page,the provider canCreate a new, blank claimCreate a new claim from a copy of apreviously submitted claimComplete a claim the provider savedpreviouslyView the submitted claimsDirect SubmitThrough the Magellan application Direct Submit,HIPAA-compliant electronic data interchange (EDI)837 files can be sent directly to Magellan in bulk,without accompanying claim data entry or theinvolvement of a clearinghouse. Direct Submit isavailable to all Presbyterian Centennial Careproviders regardless of claims submission volume.9-112014 Practitioner and Provider Manual - Ver. 3