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 is already in place for primary care
physicians who participate in the Quality Incentive Payment System (QIPS)
program and will apply to all participating providers including those
contracted with Magellan for Behavioral Health, Inc. 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. Each submission is assigned a unique adjustment
identification (ID) number. You will be able to access IBC?s response 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.
Magellan Behavioral Health, Inc., an independent
company, manages mental health and substance abuse benefits for most IBC
members.
NaviNet® is a registered trademark
of NaviNet, Inc., an independent company.