Magellan Healthcare
Provider Focus Newsletter
News & information for Magellan network providers

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Got claims? Here are some tips to help ensure timely payment

Want to avoid the claims appeals process?

With our Claims Tips, you can brush up on best practices that will help ensure your claims are paid timely:

 

Top reasons your claims could deny:

  1. The claim was a duplicate submission (i.e., the expense was previously considered).
  2. You did not obtain preauthorization when required by member's benefit plan.
  3. The member is ineligible or their coverage lapsed.
  4. The claim was not submitted within timely filing limits (under Magellan's policies and procedures, the standard timely filing limit is 60 days).
  5. The UB-04 claim does not follow correct coding requirements.
  6. The primary insurance carrier’s Explanation of Benefits (EOB) or the member’s Coordination of Benefits (COB) form is needed.
  7. The claim includes a non-covered diagnosis or service. 

See the Magellan National Provider Handbook (PDF), Section 5 for policies about provider reimbursement.

 

For California providers only: claims settlement practices and dispute resolution

You have access to an additional California claims resource (PDF), available in the appendix of the California handbook supplement, which we developed to comply with state regulations.

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About Provider Focus

Welcome to Provider Focus, our award-winning e-newsletter for network providers! Here you’ll find articles and information to keep you up-to-date on news and topics relevant to serving Magellan members, including a section for regional- and plan-specific news. Check back as a new issue is released each quarter.

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