In 2011 we introduced our provider self-service
initiative, which requires providers to use our automated tools for member
eligibility and claim status inquiries. We are now expanding the provider
self-service requirements to include questioning of claim payment or to request
a claim adjustment. This requirement includes those contracted with Magellan
Behavioral Health, Inc. for PPO business.
Effective May 1,
2013, providers who call Customer Service to question claim payment or
to request a claim adjustment will be directed to submit the request via the
NaviNet web portal. NaviNet offers the Claim INFO Adjustment transactions to
ensure your claim adjustment requests are addressed in the most efficient
manner available.
The Claim INFO Adjustment Submission transaction
allows ancillary, facility, and professional providers to submit adjustment
requests or question claim payment for paid or denied claims for a period of up
to 18 months after adjudication of the original claim or as required by
applicable law. You will be able to access a response from AmeriHealth within
ten business days through the Claim INFO Adjustment Inquiry transaction. You
may call Customer Service if you do not receive a response within ten business
days of the submission. Please have your adjustment ID number available as this
information will be required when you call.
To access the Claim INFO Adjustment Submission
transaction, select Claim Inquiry and
Maintenance from the Plan Transactions menu. Detailed user guides for
this transaction are available on our Plan Central page under Administrative
Tools & Resources.
If your office location is not yet registered for
NaviNet, you must do so by April 1, 2013. To register, please visit NaviNet and select Sign Up from the top right. If your office is
currently NaviNet-enabled, but would like training on how to submit a claim
adjustment or retrieve a response to a submitted request through NaviNet,
please contact our eBusiness Provider Hotline at 215-640-7410 for providers in Pennsylvania and Delaware or
609-662-2565 for providers in New Jersey.
Magellan Behavioral Health, Inc. manages mental
health and substance abuse benefits for most AmeriHealth members.
NaviNet® is a registered trademark
of NaviNet, Inc.